Chemical Cocktails Revisited

The grayness has set in and the raindrops are falling.  I knew the glorious weather of last week wouldn’t hold, but at least a few of the hummingbirds are still coming by. They do seem to come more on gray days.

I switched to the new drug routine yesterday and am waiting for the new adventures to begin. Nothing like the whiff of an illness or a change in drug routines to make you monitor every body process you’ve got going on.

The Popsicle Report:  Unfortunately, a Popsicle is no longer part of the routine.

The new drug, Taxol, isn’t as likely to induce mouth sores, so no need for the sweet treat to cool the mouth during infusion. I suppose I could put on a pathetic face and ask for one anyway (surely the nurses wouldn’t deny me?).  Or I could just live vicariously through my children.  My daughter got a Popsicle last week after her flu shot (orange).  I could probably drag my son in for a shot and a Popsicle, but he’s less willing to cooperate when it comes to needles, at least needles that are poked into him. When my husband jokingly offered him the chance to give me the Neupogen shot last week, his eyes got really big with interest.  “Can I give you the shot, Mom?”

No. No. And no.

Instead of the Popsicle, I get to plunge my hands in a bucket of ice during the infusion.  The main side effects of Taxol are neuropathy (burning, tingling, etc.) in the fingers and toes, and possibly bone/joint/muscle pain.  The principle behind the bucket of ice is the same as with the Popsicle — cool the area likely to be affected and you might diminish the side effects.

Isn’t science amazing.

The infusion procedure is similar to the Adriamycin — check in, check the blood count, and proceed as long as the numbers look OK.  My white and red cells are holding steady, though a little below normal.  The Taxol isn’t supposed to be as hard on the bone marrow as the other drugs, so I may be able to stop the injections of Neupogen, and the nurses say we don’t worry about the red cells unless I get to a point that walking across a room leaves me winded.

Next comes the happy drug, the dexamethasone, and then my chemical cocktail — a mixture of 25 ml of Benadryl and 50 ml of Zantac.  These are designed to forestall any allergic reaction to the Taxol.  Even though the Zantac is primarily used for stomach problems, it also acts as an antihistamine.  And Benadryl just knocks you out. (Stories abound of parents using the stuff to manage their children on long car trips.)  Then the nurse sat with me for 10-15 minutes to see if there would be a reaction. Since it didn’t happen on the first round, it’s not likely to happen in later rounds.

I can attest to the soporific effects of Benadryl. I dozed during most of the infusion (about an hour, longer than the previous ones), and needed a nap when I got home. The energy of the happy drug isn’t enough to counteract the sleepiness, but the dexamethasone does last longer.  It makes for a bit of a roller coaster though:  Up, crash, up.

I visited again with the naturopath last week.  He’s the one who suggested the bucket of ice, and he’s added a few things to compensate for the Taxol.  He’s put me on a Vitamin D supplement (5,000 IU daily) since I’m low.  Given the climate here, that’s not surprising and there’s ongoing research looking into the connections between Vit. D levels and breast cancer and multiple sclerosis, both of which occur at higher rates in the Pacific NW.

He’s recommended substituting melatonin for the Ativan I’ve been taking at night, but I’ll have to taper the Ativan, not just go cold turkey.  I continue with the fish oil, CoQ10, and probiotic supplement. He also added L-glutamine, a gritty sort of powder to be taken twice a day, mixed in something palatable.  Glutamine supports the immune system, can help prevent neuropathy, and supposedly helps build muscle strength.  Some body builders incorporate it into their routine.  Next time you see me, I might just look like Arnold Schwarzenegger, before he became plastic.

And then there’s a jar of something called Amla Plex, an Ayurvedic concoction of Indian gooseberry and a variety of herbs that support the immune system.  Vile-looking stuff it is.  Mushy. Black.  To be spread on toast or (gulp!) eaten by the spoonful.  It doesn’t smell too bad, though, so maybe its appearance is deceiving.  I haven’t tried it yet.

And he also recommended beets.  My liver enzymes were a bit whacked out a few weeks ago.  He tells me beets are great for cleansing the liver.  Got a dirty liver?  Eat beets.

We also had an interesting discussion about that list of carcinogens I found last week.  I asked him why some elements showed up on the list but don’t appear as risk factors for a disease.  He speculated that there are powerful business/financial forces that interfere (gee, no surprise there), and used BPA as an example.  That’s the plastic softener that’s currently under fire in the U.S. and has been recently banned in Canada.  It’s used in everything from baby bottles to, as he described it, the linings of the bags that my chemotherapy drugs come in.  So I may actually be getting a (bonus?!) cancer-causing agent with my infusions.

Yep, isn’t science amazing.

Here’s hoping the cancer-inducing agents will cancel each other out…

The Politics of Cancer Drugs

Another gorgeous day with The Mountain. We’re having a lucky string of beautiful days, but it can’t be Indian summer yet (she says, fingers crossed) because we haven’t had a frost.

The happy drugs are still at work, so I feel good and managed to do this morning ALL those dastardly exercises I’m supposed to be doing every day.  I’ve been frustrated at the slow progress of regaining full arm motion and getting rid of residual numbness and pain. The surgery was back in mid-June, after all. But the physical therapist says chemotherapy slows everything down, so she thinks I’m doing fine.

The Popsicle Report:  Doesn’t matter what shade it is — light, medium or dark — green is a yucky flavor.

I passed the halfway point of chemo yesterday (yeah!) with the last infusion of the Adriamycin, and will finish off the Cytoxan this week. White cells are at 3.8, a little low, but still manageable for continuing treatment.  I should be getting a flu shot, but would like to wait till the white cells are back up into normal range.

My next lesson in chemistry comes with the drug I switch to next week — Taxol.  This drug was developed beginning in the 1960s from the bark of the Pacific yew tree (a more appealing source than the red dirt Adriamycin came from!). The original tree, Taxus brevifolia, was found in a forest north of the town of Packwood, out here in Washington, so it seems I’m in the neighborhood of its origin. But there were delays along the research road, which included fights, even in Congress, over who had fair claim to it and its trademarked name, and ecological concerns about the destruction of the trees for the sake of collecting the bark. So the drug only came into use in the late 1980s. Fortunately, alternate sources for Taxol have been developed, so the Pacific yew tree is safe once more.  Taxol is also used to treat lung, ovarian, and head/neck cancer.

The messy details of the drug’s development give some credence to the claim by pharmaceutical companies that drugs are expensive to research and produce (thus justifying their high costs), but it’s sad to see how politics and greed get in the way of important drugs reaching patients.  On the other hand, there’s the problem of drugs being released before there is sufficient follow-up data to be sure they’re safe. A recent example are the reports that are starting to surface about the Gardasil vaccine for the HPV virus. This one doesn’t affect me directly, but my daughter falls into the age group it’s being recommended for.

As with Adriamycin and Cytoxan, Taxol goes after rapidly dividing cells, so again there are the side effects of hair loss and mouth sores, along with the added possibility of neuropathy (tingling, burning and other nerve problems) in fingers and toes. The infusion will take about an hour, longer than what I’ve been having, but I don’t know if that time includes a Popsicle. There are other side effects, some of which are related not to the drug but to the solution the drug is suspended in for infusion. So along with my happy drug, dexamethasone, I’ll also have to take some Benadryl and Zantac before the infusion to prevent an allergic reaction. The nurse said she’d need to sit with me for the first 15 to 20 minutes of the first infusion to monitor for any reaction. Apparently, if it’s going to happen, it happens the first time, but not after that.  (Gee, nothing like a little heightened anxiety for making the switch.)  But she also said that, compared to the drugs I’m on now, Taxol is “a walk in the park.” Makes you wonder what kind of parks these nurses walk in.

As cancer-treating drugs go, Taxol does seem a bit safer than Adriamycin and Cytoxan, which both show up as known or probable carcinogens on the list put out by the American Cancer Society. If you want to see what else is on the list, you can find it at:  http://www.cancer.org/docroot/PED/content/PED_1_3x_Known_and_Probable_Carcinogens.asp

You’ll recognize some of the standard elements we’ve heard about: asbestos, formaldehyde, radium, and mustard gas.  But there are some surprising items listed too: betel nut, Chinese-style salted fish.  And chimney sweeps and furniture manufacturers beware — your whole profession can induce cancer.

Other cancer-fighting treatments show up on the list as well.  Tamoxifen, widely used in treating certain types of breast cancer (but not mine) is there, as is arsenic, which the infusion nurse tells me is used in minute amounts for a certain type of leukemia.  People undergoing that treatment get a small dose every day (including weekends) over the course of a year.  This idea of using cancer-inducing substances to treat cancer is a bit like the “hair of the dog” cure for a hangover. “Here, take some of what can make you sick. You’ll feel better!”  (By the way, alcohol consumption shows up on the carcinogen list too.)

Two other items that show up on the list are birth control pills and hormone replacement therapy (HRT), estrogen being the culprit behind both. If you look at lists of risk factors for breast cancer published for the general public (for example: http://www.mayoclinic.com/health/breast-cancer/DS00328/DSECTION=risk-factors), you’ll see HRT there. But the use of birth control pills is conspicuously absent from that list. So here is yet another gray area in the world of medicine and science with respect to cancer. What do we really know about the causes (because all of us with this diagnosis rack our brains trying to figure out how we got it) and why is there so much conflicting information about it?

The harder you look, the more elusive the answers.

So I comfort myself by looking at the surprising connections arising from my situation.  During a bout of warm sunny weather a few weeks back, I was basking out on the deck, head uncovered, taking care of paperwork, phone calls, etc. The hummingbirds had no interest in me this time, but the next morning I noticed my scalp was pink.  A bit of a sunburn there.  As I was describing the situation to my dad on the phone later that day, he said “Yeah, that happens to me every year.”  And in a different phone conversation, my brother admitted that he has the same problem, adding “just wait till it starts to peel.”

Never thought I’d be commiserating with my male relatives about a sunburned head.