Side Effects

Bilateral mastectomies were a must for me. The impact was minimal. I am a strong woman. I am not defined by my breasts. Life and love win. Cancer lost. I have a rather large laceration from melanoma surgery on the upper part of my leg. It is about 8 inches in length and 3 inches or so, wide. Its depth is about 1/2 inch to 3/4 inch, and the rather large muscle shows clearly. It was much too large to be closed with stitches. I chose to devise my own measures to conceal it rather than have more surgery involved in disguising it. I merely wear knee length shorts when exercising, longer-length styled trunks when swimming. The viewing of the wound does not bother or cause concern to me or my immediate family in the least.

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. Getting by is definitely what you do. I did not try to attend everything with my girls. We would talk about what do you want Mom to be at and what can you go to with a friend. I took a lot of naps. We planned the meals for the week and ate really simple to prepare meals. Raw carrots and apples were a staple. Buy the cut up fruit or have a neighbor come wash and cut up your fruits and veggies for you. My husband did a lot of the cooking. To build strength, try to do a little bit more. At first I could not even walk around the block. So I would just go to the end of the driveway. I was in physical therapy for my arm and shoulder. The chemo messes with all your muscles. Try to move all your different muscle groups, even if you are lying down. Point and flex your toes 10 times, Raise and lower your arms 10 times, flex and relax your gluts, then your stomach. If you are watching TV, do a few reps of something during the ads. Drink a lot of water!

Give yourself lots of extra time. It took tons of energy to shower and get dressed. So I would get ready and then rest on the couch near the kitchen for 20 minutes. I could answer questions from everyone but not be tempted to do stuff for them. I did the same thing after school. I would be on the couch in the room that my girls play in. They would bring me a drink and I could help with homework or sign papers or talk. But I did not get up if I could avoid it. If someone else can do what you need done, then ask someone to do it. Only do what is important to you and will help you get better.

I would start a task and not be able to finish it. This gets really frustrating. And my husband would get frustrated at the mess I made that he had to clean up or finish. I had to acknowledge how weak I was and learn to ask for help and let go of things that do not really matter. Your priorities will change and your standards of what is acceptable. Decide what is important to you and let the rest go. You will get stronger but it is a very gradual process.

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. Four months after my treatments were over, I had started a cancer wellness fitness class. It was only the 2nd week and I over did it. We did a set of 10 lunges in the class. It felt okay at the time but the next day I could barely walk. My physical therapist says that my large muscles needed more time to recover between repetitions after chemo damage. Do one rep and rest for several minutes. Then try another rep. He thought doing 10 in a row was too much and my body could not reset. Physical therapy was the treatment. They taught me how to check the alignment of my hips and gave me ways to reset them if they were uneven. Then we worked on strengthening the different muscle groups that stabilize your hips.

Everyone is different ... my doctors told me not to expect any noticeable side effects from herceptin, however, I do have them.
My exhaustion levels are still so high. At first the doc blamed recovery from other chemo, but at this point believes it's the herceptin causing it.
Also, for about 2-3 days after infusion I have flu-like symptoms (very achey and sore and more tired). And for about a week I get taxol-recall joint pain.
That said, my doctors have said this isn't common BUT I have reacted strongly to everything we've done so far and they theorize that my body is just hyper-sensitive. Chances are you aren't and won't deal with it, but I share on the off chance you do get side effects, you're not crazy or imagining it! Taking trastuzumab (herceptin) was no problem at all compared to the other drugs I was taking (carboplatin, taxotere). That said, the nurses told me that there were no side effects, but I was certain that I felt fatigue from the herceptin on the day of administration. After every infusion I strongly needed a nap before continuing on with my day. But I know other women who did not have this side effect.

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
----------
* 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
----------------
* 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!!! 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
----------
* 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
----------------
* 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!!!

The best way to deal with fatigue from radiation therapy is creating a balance between getting enough rest and staying active enough. To succumb to the fatigue and give up physical activity would create a vicious cycle resulting in less energy and more fatigue. Yet you don't want to push yourself too much. It is all right to go to bed earlier, get up a little bit later or even take a nap during the day if one feels that tired but it is important to schedule a routine daily activity such as walking and stick with it throughout the course of radiation therapy. The other very important factor is to stay hydrated. Dehydration would negatively impact one's level of energy and may even interfere with their sleep pattern. This is particularly important during the warmer seasons and during the routine daily activity. Extremes of temperature should be avoided. A minimum of 8 cups of fluid per day will prevent dehydration. (That is 64 ounces, 2 quarts, or 1 half-gallon). Beverages containing caffeine do NOT count neither do alcoholic ones. Maintaining good nutrition can help you feel better and have more overall energy. Sticking to a regular schedules such as going to bed at a certain time and eating at regular hours would also be very helpful in creating that fine balance between resting and staying active. The best way to deal with fatigue from radiation therapy is creating a balance between getting enough rest and staying active enough. To succumb to the fatigue and give up physical activity would create a vicious cycle resulting in less energy and more fatigue. Yet you don't want to push yourself too much. It is all right to go to bed earlier, get up a little bit later or even take a nap during the day if one feels that tired but it is important to schedule a routine daily activity such as walking and stick with it throughout the course of radiation therapy. The other very important factor is to stay hydrated. Dehydration would negatively impact one's level of energy and may even interfere with their sleep pattern. This is particularly important during the warmer seasons and during the routine daily activity. Extremes of temperature should be avoided. A minimum of 8 cups of fluid per day will prevent dehydration. (That is 64 ounces, 2 quarts, or 1 half-gallon). Beverages containing caffeine do NOT count neither do alcoholic ones. Maintaining good nutrition can help you feel better and have more overall energy. Sticking to a regular schedules such as going to bed at a certain time and eating at regular hours would also be very helpful in creating that fine balance between resting and staying active.

This may vary depending on the individual and their risk for bone density loss or fracture. It is important when starting an aromatase inhibitor that you have a baseline bone mineral density study (referred to as a DEXA scan) and a clinical assessment for other potential risk factors for osteoporosis (defined as a T score < 2.5 on a DEXA scan by the World Health Organization). These risks include older age, previous fracture, low body weight, current tobacco use, and excessive alcohol consumption, among others. I encourage all women starting an aromatase inhibitor to adopt lifestyle changes that promote not only bone health but overall health as well. These include increasing physical activity (including weight bearing exercise), stopping smoking, and taking calcium and vitamin D supplements. Some individuals starting an aromatase inhibitor may be advised to take drug therapy with bisphosphonates if they have osteoporosis or a history of a fracture or osteopenia (http://www.medterms.com/script/main/art.asp?articlekey=8048)(T-score between -1 and -2.5 on a DEXA scan) with other risk factors. There is no consensus on the optimal strategy for monitoring but every two years is a common strategy. This may vary depending on the individual and their risk for bone density loss or fracture. It is important when starting an aromatase inhibitor that you have a baseline bone mineral density study (referred to as a DEXA scan) and a clinical assessment for other potential risk factors for osteoporosis (defined as a T score < 2.5 on a DEXA scan by the World Health Organization). These risks include older age, previous fracture, low body weight, current tobacco use, and excessive alcohol consumption, among others. I encourage all women starting an aromatase inhibitor to adopt lifestyle changes that promote not only bone health but overall health as well. These include increasing physical activity (including weight bearing exercise), stopping smoking, and taking calcium and vitamin D supplements. Some individuals starting an aromatase inhibitor may be advised to take drug therapy with bisphosphonates if they have osteoporosis or a history of a fracture or osteopenia (http://www.medterms.com/script/main/art.asp?articlekey=8048)(T-score between -1 and -2.5 on a DEXA scan) with other risk factors. There is no consensus on the optimal strategy for monitoring but every two years is a common strategy.

Aromatase inhibitors lower estrogen levels in your body and this estrogen deficiency leads to increased bone turnover and bone loss. This side effect, however, does not reflect whether the medication is working for your breast cancer. Estrogen is known to stimulate hormone receptor positive breast tumor cells and aromatase inhibitors are very effective at lowering estrogen levels and thereby removing this growth signal and resulting in tumor cell death. Thus, the lowering of estrogen is a critical reason why these drugs work so well to treat hormone receptor positive breast cancer but may have, at the same time, a negative impact on bone health. Aromatase inhibitors lower estrogen levels in your body and this estrogen deficiency leads to increased bone turnover and bone loss. This side effect, however, does not reflect whether the medication is working for your breast cancer. Estrogen is known to stimulate hormone receptor positive breast tumor cells and aromatase inhibitors are very effective at lowering estrogen levels and thereby removing this growth signal and resulting in tumor cell death. Thus, the lowering of estrogen is a critical reason why these drugs work so well to treat hormone receptor positive breast cancer but may have, at the same time, a negative impact on bone health.

Constipation is an expected and predictable side effect of opioid medications. It is one of the few side effects to which a patient will never develop tolerance, in other words, this side effect will never go away. For these reasons it is most important that a patient is provided with a prescription for a bowel regimen to prevent constipation whenever they are started on an opioid medication. In general, patients are started on a laxative such as sennakot, and a stool softener, such as docusate. If patients become constipated despite the prophylaxis they may be started on additional laxatives such as lactulose, dulcolax or miralax. Patients who are taking opioids and do not have a bowel movement for >48 hours despite being on a bowel regimen should be in contact with their physician for further recommendations and treatment. Constipation is an expected and predictable side effect of opioid medications. It is one of the few side effects to which a patient will never develop tolerance, in other words, this side effect will never go away. For these reasons it is most important that a patient is provided with a prescription for a bowel regimen to prevent constipation whenever they are started on an opioid medication. In general, patients are started on a laxative such as sennakot, and a stool softener, such as docusate. If patients become constipated despite the prophylaxis they may be started on additional laxatives such as lactulose, dulcolax or miralax. Patients who are taking opioids and do not have a bowel movement for >48 hours despite being on a bowel regimen should be in contact with their physician for further recommendations and treatment.

When approaching a patient with pain, the first step is to do a very thorough pain history to determine the etiology of pain, severity of pain, duration of the pain and the impact of the pain on the patient’s life and physical functioning. The etiology of the pain will guide us to understand the expected duration of the pain and the approaches that are most likely to be effective in treatment. For cancer patients in moderate to severe pain, opioid pain medications are often effective. We may use opioid pain medications in conjunction with acetaminophen or non-steroidal anti-inflammatories (NSAIDs). Our goal in treating patients is to get a stable control of pain with a standing medication regimen, with the availability of “breakthrough” or “rescue” medications for acute exacerbations of pain that may occur. When starting patients on new pain medication regimens we make sure to have close follow-up with patients to assess for efficacy as well as side effects of the regimen. We also make use of other members of the interdisciplinary palliative care team, including our massage therapists to assist in pain management. Certain cancer pain syndromes may also be amenable to interventional procedures such as nerve blocks, in which case we work with and make referrals to our colleagues in Anesthesiology who specialize in interventional pain management. When approaching a patient with pain, the first step is to do a very thorough pain history to determine the etiology of pain, severity of pain, duration of the pain and the impact of the pain on the patient’s life and physical functioning. The etiology of the pain will guide us to understand the expected duration of the pain and the approaches that are most likely to be effective in treatment. For cancer patients in moderate to severe pain, opioid pain medications are often effective. We may use opioid pain medications in conjunction with acetaminophen or non-steroidal anti-inflammatories (NSAIDs). Our goal in treating patients is to get a stable control of pain with a standing medication regimen, with the availability of “breakthrough” or “rescue” medications for acute exacerbations of pain that may occur. When starting patients on new pain medication regimens we make sure to have close follow-up with patients to assess for efficacy as well as side effects of the regimen. We also make use of other members of the interdisciplinary palliative care team, including our massage therapists to assist in pain management. Certain cancer pain syndromes may also be amenable to interventional procedures such as nerve blocks, in which case we work with and make referrals to our colleagues in Anesthesiology who specialize in interventional pain management.

Even though the new radiation technology has given us the capability to spare patients from significant skin burns, depending on the type of cancer and its location, sometimes either the skin itself is the target of radiation or it is impossible to spare it completely. Skin burn from radiation in many ways is similar to a sunburn. There are a number of products that radiation oncologists may recommend to alleviate the discomfort from the skin burn. These include but are not limited to Aquaphor ointment, Miaderm Lotion, Aloe Vera gel, Calendu, RadX Radiation Therapy cream, Radia-Guard lotion and many other products. If the skin has blistered or the shiny and moist part of skin is exposed Silvadene cream and/or a variety of gel wound dressings may be recommended. In worst case scenarios, your radiation oncologist may decide to advise a break in the course of treatment but this has to be weighed carefully against the negative impact of breaks during radiation on the final outcome of treatment. Avoiding sun exposure and products containing alcohol is advisable. Cleaning the area with mild and fragrance-free soap and water to prevent infection is essential. If the affected area is in perineal area, sitz baths with water and Hydrogen Peroxide would be helpful. Women should avoid wearing wired bras if the treatment area includes the chest. Please do not use any product without consulting your radiation oncologist first. Even though the new radiation technology has given us the capability to spare patients from significant skin burns, depending on the type of cancer and its location, sometimes either the skin itself is the target of radiation or it is impossible to spare it completely. Skin burn from radiation in many ways is similar to a sunburn. There are a number of products that radiation oncologists may recommend to alleviate the discomfort from the skin burn. These include but are not limited to Aquaphor ointment, Miaderm Lotion, Aloe Vera gel, Calendu, RadX Radiation Therapy cream, Radia-Guard lotion and many other products. If the skin has blistered or the shiny and moist part of skin is exposed Silvadene cream and/or a variety of gel wound dressings may be recommended. In worst case scenarios, your radiation oncologist may decide to advise a break in the course of treatment but this has to be weighed carefully against the negative impact of breaks during radiation on the final outcome of treatment. Avoiding sun exposure and products containing alcohol is advisable. Cleaning the area with mild and fragrance-free soap and water to prevent infection is essential. If the affected area is in perineal area, sitz baths with water and Hydrogen Peroxide would be helpful. Women should avoid wearing wired bras if the treatment area includes the chest. Please do not use any product without consulting your radiation oncologist first.

Routine, follow-up physical examinations are vital for the cancer survivor. Communication with the physician of any side-effects experienced is the best way to monitor and keep track of long-term side-effects. The healthcare provider will be able to follow, monitor, and chart in the medical record any and all of the side-effects experienced. This helps the physician look for any patterns or changes in symptoms over time. Many cancers also give off tumor markers that can be followed by specific blood tests, warning the physician that there is a possibility that cancer changes are occurring; for example, the CEA test for colorectal cancer or the CA 125 test for ovarian cancer.

Hopefully, the healthcare team educates the patient about which long-term side-effects may be expected from which specific cancer and treatment experienced, for example, radiation therapy to the chest may cause long-term fibrosis of the lung fields causing a dry, non-productive cough or shortness of breath on exertion with exercise. The patient will then know what may be a permanent long-term side-effect and be able to differentiate this from an abnormal symptom that arises; for example, a wet productive cough.

Every survivor should be familiar with side-effects that are not normal from expected long-term side-effects. The American Cancer Society uses the algorithm C-A-U-T-I-O-N to outline the seven warning signs of cancer: C=changes in bowel or bladder habits, A= a sore that does not heal, U= unusual bleeding or discharge from any place, T= thickening or lump in the breast or elsewhere, I= indigestion or difficulty swallowing, O= obvious change in a wart or mole, and N= nagging cough or hoarseness. These warning signs can be indicative of a new cancer or a recurrent cancer and any change in symptoms should warn the patient to bring these to the attention of the physician. Other symptoms that should be monitored include any unusual fever, chills, or night sweats which can be indicative of malignancy or recurrence along with any unusual nausea, vomiting, or anorexia. A very important symptom to monitor is unusual, unintended weight loss.
Routine, follow-up physical examinations are vital for the cancer survivor. Communication with the physician of any side-effects experienced is the best way to monitor and keep track of long-term side-effects. The healthcare provider will be able to follow, monitor, and chart in the medical record any and all of the side-effects experienced. This helps the physician look for any patterns or changes in symptoms over time. Many cancers also give off tumor markers that can be followed by specific blood tests, warning the physician that there is a possibility that cancer changes are occurring; for example, the CEA test for colorectal cancer or the CA 125 test for ovarian cancer.

Hopefully, the healthcare team educates the patient about which long-term side-effects may be expected from which specific cancer and treatment experienced, for example, radiation therapy to the chest may cause long-term fibrosis of the lung fields causing a dry, non-productive cough or shortness of breath on exertion with exercise. The patient will then know what may be a permanent long-term side-effect and be able to differentiate this from an abnormal symptom that arises; for example, a wet productive cough.

Every survivor should be familiar with side-effects that are not normal from expected long-term side-effects. The American Cancer Society uses the algorithm C-A-U-T-I-O-N to outline the seven warning signs of cancer: C=changes in bowel or bladder habits, A= a sore that does not heal, U= unusual bleeding or discharge from any place, T= thickening or lump in the breast or elsewhere, I= indigestion or difficulty swallowing, O= obvious change in a wart or mole, and N= nagging cough or hoarseness. These warning signs can be indicative of a new cancer or a recurrent cancer and any change in symptoms should warn the patient to bring these to the attention of the physician. Other symptoms that should be monitored include any unusual fever, chills, or night sweats which can be indicative of malignancy or recurrence along with any unusual nausea, vomiting, or anorexia. A very important symptom to monitor is unusual, unintended weight loss.

First, I hope that you have undergone adequate lymphedema treatment. There are treatments available and most are now covered by insurance. Treatments include compression sleeves, manual lymph drainage (MLD) by specialty trained lymphedema therapists, special bandaging, sequential gradient pump, or some medications (although diuretics have proven to have little effect). Of course if your lymphedema is ever caused or made worse by an infection, then antibiotics should be prescribed.

You mention feeling isolated and embarrassed by the lymphedema. This may be due to the fact that you feel the lymphedema is a sign that you had cancer and the diagnosis in itself is one that you struggle with. It may be difficult for you to tell people why you have lymphedema if asked, or you may be afraid that you will be asked and the cancer is an experience you don’t want to talk about. Did you have body-image concerns prior to the cancer that have been exacerbated by the lymphedema? If you answered yes to these questions, you may have underlying emotional issues that are unresolved and that are triggering your embarrassment and isolation. I would strongly recommend seeking out a therapist who can help you overcome these painful issues. You can also reach out to lymphedema societies that provide ongoing support for patients who suffer from lymphedema: the National Lymphedema Network at 1-800-541-3259 or http://www.lymphnet.org; the Lymphedema International Network at http://www.lymphedema.com. First, I hope that you have undergone adequate lymphedema treatment. There are treatments available and most are now covered by insurance. Treatments include compression sleeves, manual lymph drainage (MLD) by specialty trained lymphedema therapists, special bandaging, sequential gradient pump, or some medications (although diuretics have proven to have little effect). Of course if your lymphedema is ever caused or made worse by an infection, then antibiotics should be prescribed.

You mention feeling isolated and embarrassed by the lymphedema. This may be due to the fact that you feel the lymphedema is a sign that you had cancer and the diagnosis in itself is one that you struggle with. It may be difficult for you to tell people why you have lymphedema if asked, or you may be afraid that you will be asked and the cancer is an experience you don’t want to talk about. Did you have body-image concerns prior to the cancer that have been exacerbated by the lymphedema? If you answered yes to these questions, you may have underlying emotional issues that are unresolved and that are triggering your embarrassment and isolation. I would strongly recommend seeking out a therapist who can help you overcome these painful issues. You can also reach out to lymphedema societies that provide ongoing support for patients who suffer from lymphedema: the National Lymphedema Network at 1-800-541-3259 or http://www.lymphnet.org; the Lymphedema International Network at http://www.lymphedema.com.

Fatigue is one of the most distressing side-effects of cancer treatment and a side-effect that negatively impacts quality of life. Unfortunately, fatigue does not disappear when treatment ends. Many patients have reported that fatigue post-treatment is ongoing and long-lasting. As a cancer survivor who underwent six surgeries, chemotherapy, and radiation therapy, I felt that it took over two years for me to feel like I had returned to a sense of normalcy in regard to energy and exercise. Fatigue can be physical, mental, or both. The treatment of course depends on the cause but there are general preventive strategies and then ways of taking care of oneself in order to heal and re-nourish.

If you are working long hours or doing more physical work, allow yourself more time to sleep and rest. Take work breaks to sit and rest. Delegate tasks if possible during times of stress. Ask your nurse or physician about taking vitamin or mineral supplements and consider eating smaller meals 4-6 times per day to help you maintain a higher energy level. Avoid foods that contain a lot of sugar and avoid caffeine, alcohol, and other drugs.

Taking care of yourself is always a challenge! Getting enough rest and sleep is vital. Sleep hygiene includes basic measures such as staying in bed only to sleep, establishing a routine wake time and bedtime (creating a bedtime routine), avoiding caffeine and alcohol and heavy meals before bed, no napping after 3 p.m., etc. It is important to talk to your healthcare provider about insomnia. The use of relaxation techniques such a progressive muscle relaxation, guided imagery, and yoga are measures that help aid restorative rest and sleep.

A major strategy to offset fatigue is to walk or exercise according to your healthcare provider’s recommendations. Exercise can increase your energy and boost your mood! If fatigue is caused by undue emotional stress then counseling is advised. Lastly, allow yourself time to relax and carry out activities that you enjoy! Developing new interests and being stimulated by new friends, new work, etc., can help with emotional fatigue which is often a side-effect of physical fatigue.
Plan your day. Be active at the time of day when you feel most alert and energetic.Choose how to spend your energy. Try to let go of things that don't matter so much.

Side effect of radiation therapy entirely depends on the area we are irradiating. For example the side effects of radiation the the brain because of a brain metastasis are entirely different from the side effects due to the radiation of a bone metastasis in a bone. Generally speaking though some fatigue and minor skin reaction would be involved with radiation no matter where it is given. Due to significant improvements in the radiation technology in the past couple of decades, we are increasingly capable of sparing most of normal tissue and critical organs from unnecessary radiation and focus radiation on the area we intend to irradiate. That is even in radiation therapy field we are moving into the direction of targeted therapy and are able to deliver higher doses of radiation to the cancer only without causing major side effects which is usually as a result of unnecessary radiation to the normal tissues. Side effect of radiation therapy entirely depends on the area we are irradiating. For example the side effects of radiation the the brain because of a brain metastasis are entirely different from the side effects due to the radiation of a bone metastasis in a bone. Generally speaking though some fatigue and minor skin reaction would be involved with radiation no matter where it is given. Due to significant improvements in the radiation technology in the past couple of decades, we are increasingly capable of sparing most of normal tissue and critical organs from unnecessary radiation and focus radiation on the area we intend to irradiate. That is even in radiation therapy field we are moving into the direction of targeted therapy and are able to deliver higher doses of radiation to the cancer only without causing major side effects which is usually as a result of unnecessary radiation to the normal tissues.

Insomnia is a really common problem for cancer patients. Although there are very effective prescription medications out there, most have some unwanted side effects. Effective nonprescription treatments for insomnia include regular exercise (preferably not just before bedtime), a balanced diet, meditation, acupuncture, and yoga just to name a few. For those of you who are still intent on taking a little something at bedtime to help you sleep, I usually recommend some combination of hops, valerian, lemon balm, and/or passion flower. Chamomile tea is helpful as well. Insomnia is a really common problem for cancer patients. Although there are very effective prescription medications out there, most have some unwanted side effects. Effective nonprescription treatments for insomnia include regular exercise (preferably not just before bedtime), a balanced diet, meditation, acupuncture, and yoga just to name a few. For those of you who are still intent on taking a little something at bedtime to help you sleep, I usually recommend some combination of hops, valerian, lemon balm, and/or passion flower. Chamomile tea is helpful as well.

This is really a common side effect with Tamoxifen treatment and all too frequently leads to discontinuation of a really helpful drug. Recommendations that are at the top of the list include regular exercise and a Mediterranean diet. Do those first. Next I would consider acupuncture. There was a study in the Journal of Clinical Oncology a couple of years ago that compared acupuncture to an antidepressant drug commonly used for hot flashes called Effexor. Acupuncture was just as effective in decreasing hot flashes and patients reported increased libido, and improvements in energy, clarity of thought, and sense of well-being with acupuncture. Side effects for the Effexor group included dry mouth, nausea, constipation,and decreased appetite. Black cohosh is another option. I won’t go into all the weaknesses of the big studies that have been done on black cohosh and hot flashes but I’ll summarize by saying the preponderance of the evidence shows that black cohosh is effective in treating hot flashes. It is not a phytoestrogen as some have believed in the past. Many of the common herbal preparations used for hot flashes do contain phytoestrogens so I would avoid those and stick with plain black cohosh. This is really a common side effect with Tamoxifen treatment and all too frequently leads to discontinuation of a really helpful drug. Recommendations that are at the top of the list include regular exercise and a Mediterranean diet. Do those first. Next I would consider acupuncture. There was a study in the Journal of Clinical Oncology a couple of years ago that compared acupuncture to an antidepressant drug commonly used for hot flashes called Effexor. Acupuncture was just as effective in decreasing hot flashes and patients reported increased libido, and improvements in energy, clarity of thought, and sense of well-being with acupuncture. Side effects for the Effexor group included dry mouth, nausea, constipation,and decreased appetite. Black cohosh is another option. I won’t go into all the weaknesses of the big studies that have been done on black cohosh and hot flashes but I’ll summarize by saying the preponderance of the evidence shows that black cohosh is effective in treating hot flashes. It is not a phytoestrogen as some have believed in the past. Many of the common herbal preparations used for hot flashes do contain phytoestrogens so I would avoid those and stick with plain black cohosh.

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. 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. 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.