Chemo Teaching

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Yesterday Seth and I had "chemo teaching" with Maddie, my chemo nurse practitioner. It was essentially a counseling session to educate us about what to expect during my chemo treatment. Maddie, who is a warm but matter-of-fact person, covered a huge amount of information in the ninety minutes we spent with her. Since we don't yet know which arm of the study I'm going to be in, we talked about both regimens.

Arm B - T-DM1 + Perjeta

Medications
  • Prilosec - An acid reducer, used because the drugs can cause acid reflux.
  • Compazine or Ativan - Anti-nausea medications, to be taken only as needed. Ativan can also treat anxiety and insomnia.
  • Cipro - An antibiotic, to be taken in case of fever (indicating infection).

Side Effects
  • Dry skin and sun sensitivity
  • Constipation or diarrhea
  • Dry mouth
  • Fatigue

Lifestyle Limitations
  • No pedicures or manicures
  • No direct sun exposure
  • No sushi, raw sprouts, mushrooms, salad bars, or buffets.
  • No electric toothbrush
  • No herbal supplements, unless approved by Maddie or Dr. Hurvitz

Lifestyle Recommendations
  • Sunscreen, hats, and long pants and sleeves when outside.
  • Exercise (at least 30 minutes 5 days a week), which helps keep fatigue at bay, improves mood, and reduces water retention.
  • A balanced diet consisting mainly of protein, vegetables, and fruit. Smaller, more frequent meals are recommended.
  • Hydration (at least two liters of water a day).
  • Two forms of non-hormone contraception, because getting pregnant while in treatment would be disastrous.

Arm A - TCHP

Medications - Everything in Arm B, plus:
  • Decadron - A potent glucocorticoid steroid drug that has anti-inflammatory and immunosuppressant effects. This drug is required the day before and the day after treatment to control nausea and reduce hypersensitivity to the chemo drugs. The downside is that it can cause insomnia.
  • Neulasta - Stimulates white blood cell growth. This is given as a shot the day after each treatment.

Side Effects - Everything in Arm B, plus:
  • Hair loss
  • Nail discoloration
  • Altered sense of taste
  • Neuropathy (numbing/tingling of the hands or feet)
  • Loss of appetite
  • Bone pain
  • Weight gain

Lifestyle Limitations - Everything in Arm B

Lifestyle Recommendations - Everything in Arm B, plus:
  • Acupuncture, which is believed to help prevent neuropathy. It is also effective in reducing nausea and anxiety.

As I wrote before, it's very hard not to get my hopes up that I will be placed in Arm B. Being able to forgo Decadron and Neulasta would be so wonderful, and obviously, the side effects are much less extensive as well. However, if I am placed in Arm A, the Decadron should clear up my eczema, which would be nice.

Something I've been thinking about in this learning process is that there could be overlap between the chemo side effects that result directly from the drugs and the broader side effects of having cancer. For instance, slight weight gain can result from the chemo drugs due to water retention. However, weight gain due to overindulgence in comfort foods is also common - as in "I have cancer, I deserve to eat this mac n' cheese." (I have to admit, I could see doing that myself.) Another example - irritability is a side effect of Decadron, the corticosteroid I would have to take in Arm A. But couldn't irritability also be a side effect of being pissed off about having cancer? I haven't felt it myself (yet), but it seems like a reasonable reaction!

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