Wednesday, September 24, 2014

Combatting the side effects of chemo

Last week I was asked by Healthline to share their new info-graphic on the side effects of chemo.  Since it also happened to be my one-year anniversary of finishing chemo (hurray for that!), I felt it was especially appropriate.

Initially, when I checked out the info-graphic I thought, "Wow, this is great information".  It really is!  Then I realized that I had experience with most of the side-effects and my thoughts changed to, "Wow, this is depressing" "chemo sucks".  Unfortunately, these side effects exist.  Fortunately, there are ways to help combat (note: help, not eliminate) them.  So while it is unfortunate that the current cancer treatment is so incredibly harsh on the body, I feel it is important to be educated so that you can work to reduce those side effects, improve healing, and maintain a high quality of life during cancer treatment and beyond.

Below you will find the very informative info-graphic with links to the Healthline website.  Since I have had more than my fair share of experience with chemo, I have added some tips and strategies I have learned to retain health and minimize side effects during treatment and beyond.

Chemotherapy affects most of the body's systems
(taken from: Healthline

Chemotherapy drugs are powerful enough to kill rapidly growing cancer cells, but they also can harm perfectly healthy cells, causing side effects throughout the body.

The Side Effects of Chemotherapy on the Body

Cancer cells divide more quickly than healthy cells, and chemotherapy drugs effectively target those cells. Unfortunately, fast-growing cells that are healthy can be damaged too. There are many different chemotherapy drugs with the potential for many different side effects. These effects vary from person to person and from treatment to treatment.
Factors that play a role in side effects include other ongoing treatments, previous health issues, age, and lifestyle. Some patients experience few side effects while others feel quite ill. Although most side effects clear up shortly after treatment ends, some may continue well after chemotherapy has ended, and some may never go away.
Chemotherapy drugs are most likely to affect cells in the digestive tract, hair follicles, bone marrow, mouth, and reproductive system. However, cells in any part of the body may be damaged.

Circulatory and Immune Systems

Routine blood count monitoring is a crucial part of chemotherapy. That’s because the drugs can harm cells in the bone marrow, where blood is produced. This can result in several problems. Red blood cells carry oxygen to tissues. Anemia occurs when your body doesn’t produce enough red blood cells, making you feel extremely fatigued. Other symptoms of anemia include:
  • lightheadedness, pale skin, difficulty thinking, feeling cold, general weakness

Chemo can lower your white blood cell count, which results in neutropenia. White blood cells play an important role in the immune system: they help fight infection and ward off illness. Symptoms aren’t always obvious, but a low white blood cell count raises the risk of infection and illness. People with an immune system weakened by chemotherapy must take precautions to avoid exposure to viruses, bacteria, and other germs.
Cells called platelets help the blood clot. A low platelet count, called thrombocytopenia, means you’re likely to bruise and bleed easily. Symptoms include nosebleeds, blood in vomit or stools, and heavier-than-normal menstruation.
Some chemo drugs can weaken the heart muscle, resulting in cardiomyopathy, or disturb the heart rhythm, causing arrhythmia. This can affect the heart’s ability to pump blood effectively. Some chemo drugs can increase the risk of heart attack. These problems are less likely to occur if your heart is strong and healthy at the start of chemotherapy.

Jen's tips:  I worked closely with my nutritionist to utilize nutrition and supplements to support my circulatory and immune systems as best as possible.  Additionally, recommendations were made to help protect my heart from the damaging effects of an anthracycline based chemo regimen.   While there is no way to know for certain if this nutritional advice was beneficial, I will say that I did not get a single cold throughout my cancer treatment.  Additionally, no immediate heart damage from treatment has been detected.  

Nervous and Muscular Systems

The central nervous system controls emotions, thought patterns, and coordination. Chemotherapy drugs may cause problems with memory, or make it difficult to concentrate or think clearly. This symptom sometimes is called “chemo fog,” or “chemo brain.” This mild cognitive impairment may go away following treatment, or may linger for years. Severe cases can add to anxiety and stress.
Some chemo drugs can cause pain, weakness, numbness, or tingling in the hands and feet (peripheral neuropathy). Muscles may feel tired, achy, or shaky. Reflexes and small motor skills may be slowed. It’s not unusual to experience problems with balance and coordination.

Jen's tips:  Despite perceiving myself as relatively high-functioning cognitively throughout treatment, I definitely experienced "moments" of slower cognitive and motor processing.  These "moments" seemed exacerbated by fatigue and improved with exercise, and were always worse the first few days post-infusion.  To reduce symptoms of chemo brain, I recommend adequate sleep and exercise.  To help compensate for forgetfulness, task lists became imperative and are something I still find helpful today.  

I continue to experience peripheral neuropathy primarily in my hands causing my hands to get cold easily.  I don't let this slow me down; I just purchased some Bar Mits so I can continue to ride my bike in frigid weather.  

Digestive System

Some of the most common side effects of chemotherapy involve the digestive tract. Mouth sores and dry mouth can make it difficult to chew and swallow. Sores also may form on the tongue, lips, gums, or in the throat. Mouth sores can make you more susceptible to bleeding and infection. Many patients complain of a metallic taste in the mouth, or a yellow or white coating on the tongue. Food may taste unusual or unpleasant.
These powerful drugs can harm cells along the gastrointestinal tract. Nausea is a common symptom, and may result in bouts of vomiting. However, anti-nausea medications given in conjunction with chemotherapy drugs can help alleviate this symptom.
Other digestive issues include loose stools or diarrhea. In some people, hard stools and constipation can be a problem. This may be accompanied by pressure, bloating, and gas. Take care to avoid dehydration by drinking plenty of water throughout the day.
Side effects involving the digestive system can contribute to loss of appetite and feeling full even though you haven’t eaten much. Weight loss and general weakness are common. Despite all this, it’s important to continue eating healthy foods.

Jen's tips:  I found maintaining excellent oral hygiene to be the most effective strategy for combatting mouth sores.  While undergoing chemo make sure to brush your teeth after every single meal.  Use a soft-bristeled toothbrush and run warm water over it prior to using (to further soften the bristles).   Propolis is a good, natural mouth rinse.

As for digestive health, when I finished chemotherapy in 2011 I frequently had digestive issues (diarrhea).  After completing chemo once again in 2013, my Nutritionist recommended a high quality Probiotic which I have used with excellent success.  This is one of the most expensive supplements that I take, but having a healthy digestive system is worth it!  

Hair, Skin, and Nails (Integumentary System)

Many chemotherapy drugs affect the hair follicles and can cause hair loss (alopecia) within a few weeks of the first treatment. Hair loss can occur on the head, eyebrows, eyelashes, and body. As troubling as it can be, hair loss is temporary. New hair growth usually begins several weeks after the final treatment.
Some patients experience minor skin irritations like dryness, itchiness, and rash. You may develop sensitivity to the sun, making it easier to burn. Your doctor can recommend topical ointments to soothe irritated skin.
Fingernails and toenails may turn brown or yellow, and become ridged or brittle. Nail growth may slow down, and nails may crack or break easily. In severe cases, they can actually separate from the nail bed. It’s important to take good care of your nails to avoid infection.

Jen's tips:  Many of the chemotherapy regimens for breast cancer cause hair loss.  There is simply no way around it unless you are able/willing to shell out big bucks for cold caps or something similar.  Even if you cut your hair short prior to chemo, it is traumatizing and a bit (in my opinion) disgusting when hair starts to fall out in clumps.  A lint roller works great to pick up loose hair.  Coconut oil helps soothe the scalp as it becomes tender when hair falls out.  In fact, I would lather coconut oil over my entire body, especially my hands and feet, to soothe my dry, itchy, sensitive chemo skin.  Tea tree oil is the magic potion for finger/toe nails.  I developed toe nail fungus for the first time in my life.  Tee tree oil twice daily for a couple of months did the trick.  Tea tree oil also has healing properties and I use it on cuts, abrasions, and saddle sores.

Sexual and Reproductive System

Chemotherapy drugs can have an effect on your hormones. In women, hormonal changes can bring on hot flashes, irregular periods, or sudden onset of menopause. They may become temporarily or permanently infertile. Women on chemotherapy may experience dryness of vaginal tissues that can make intercourse uncomfortable or painful. The chance of developing vaginal infections is increased. Chemotherapy drugs given during pregnancy can cause birth defects. In men, some chemo drugs can harm sperm or lower sperm count, and temporary or permanent infertility is possible.
Symptoms like fatigue, anxiety, and hormonal fluctuations may interfere with sex drive in both men and women. So can worrying about loss of hair and other changes in appearance. However, many people on chemotherapy continue to enjoy an intimate relationship and an active sex life.

Jen's tips:  Whether you are in a relationship or not, if you are even considering having children in the future, I strongly recommend a consultation with a fertility specialist prior to starting chemo.  Also, check out Fertile Hope to see if you qualify for fertility preservation financial assistance.  To combat/tolerate hot flashes I recommend first and foremost exercise and healthy nutrition.  Other strategies that have worked for me include wearing layers as my body temperature fluctuates throughout the day, carrying a water bottle with me and taking a sip when I feel a hot flash coming on, and keeping the bedroom mildly cool at night when hot flashes are at their worst.  To combat the dreaded vaginal dryness, I recommend coconut oil (yes, coconut oil has many, many uses:) and Firefly Organics lubricant.  'nuff said...  

Kidneys and Bladder (Excretory System)

The kidneys work to excrete the powerful chemotherapy drugs as they move through your body. In the process, some kidney and bladder cells can become irritated or damaged. Symptoms of kidney damage include decreased urination, swelling of the hands and feet (edema), and headache. Symptoms of bladder irritation include a feeling of burning when urinating and increased urinary frequency.
You’ll be advised to drink plenty of fluids to flush the medication from your system and to keep your system functioning properly. Note: Some medications cause urine to turn red or orange for a few days. This isn’t cause for concern.

Jen's tips:  While it is well known that maintaining hydration is vital for flushing the body of toxins and supporting kidney health during treatment, exercise can have a profound impact as well.  Clearly, I am a big advocate for exercise during treatment.  I feel strongly that moderate exercise and quality nutrition are powerful tools in tolerating chemo well.  Exercise helps improve circulation and when combined with good hydration can help flush the chemo toxins from the body more quickly.  The power of exercise (cycling specifically) was driven home to me by an Exercise Physiologist at Huntsman who told me that studies show due to the increased circulation when cycling, patients on dialysis who rode a stationary bike daily, had their dialysis time significantly reduced.  He said that cycling in particular increases circulation more than any other activity.  While I haven't personally seen this research, the Huntsman EP is a smart guy and I believe him.  Think of the power this has for flushing out chemo toxins!  

Skeletal System

Most people—and especially women—lose some bone mass as they age. Some chemotherapy drugs can cause calcium levels to drop and contribute to bone loss. This can lead to cancer-related osteoporosis, especially in post-menopausal women and those whose menopause was brought on suddenly due to chemotherapy.
According to the National Institutes of Health (NIH), women who have been treated for breast cancer are at increased risk for osteoporosis and bone fracture. This is due to the combination of the drugs and the drop in estrogen levels. Osteoporosis increases the risk of bone fractures and breaks. The most common areas of the body to suffer breaks are the spine and pelvis, hips, and wrists.

Jen's tips:  Besides having another recurrence, osteoporosis and debilitating bone fractures is one of my biggest future health concerns.  There is solid research that shows that weight bearing activities and exercise are beneficial to reduce bone loss in post-menopausal women with jumping activities being the gold-standard bone loss preventative activity.  For this reason, I jump rope, wearing a weighted vest, twice weekly.  Additionally, I do a 35 minute weight routine twice weekly and trail run once weekly with the intent of maintaining bone integrity.  Push-ups, planks, and side planks are done to help maintain shoulder and wrist stability.  I also take Calcium and Vitamin D/A/K supplements for bone health.  

Psychological and Emotional Toll

Living with cancer and dealing with chemotherapy can exact an emotional toll. You may feel fearful, stressed, or anxious about your appearance and your health. Some people may suffer from depression. Juggling work, financial, and family responsibilities while undergoing cancer treatment can become overwhelming.
Many cancer patents turn to complementary therapies like massage and meditation for relaxation and relief. If you have trouble coping, mention it to your doctor. They may be able to suggest a local cancer support group where you can speak with others who are undergoing cancer treatment. If feelings of depression persist, professional counseling may be necessary.

Jen's tips:  It is completely understandable to have feelings of sadness and depression while undergoing cancer treatment and beyond.   These side effects should be discussed with your physician and appropriate medical interventions taken.  That said, as hard as it is to get out the door and exercise when tired and achy from treatment, there is not a single time that I return from a bike ride not feeling invigorated and full of life!  

Friday, September 12, 2014

I have been making a conscious effort to not be so busy all the time.  Running around, lack of sleep, and persistent stress is not good for body or mind.  That said, this past month has been craaaazy busy.  Fortunately, it was crazy in all the good ways!

It started with three consecutive weekends of racing, the first being a little 5k running race I did with Dizzy.  Although I have incorporated a weekly trail run into my training, I do NOT consider myself a runner, in fact I have never competed in a running race.  That said, a race is a race, even if it is a "fun" race and I planned on "racing".  Dizzy, apparently, had the same plan.  I typically trail run with Dizzy off leash, so I was caught a bit off guard with him charging full gallop and dragging me behind.  I'm sure we looked pretty comical, however even with a stop at the doggie pool for some wading, Dizzy's strategy proved successful and we finished 3rd overall with a time of 22:45.  I have no idea if that is fast or not.

Dizzy and me before the Friends of Animals k9-5k.
I love the hot air balloons floating in the background.

The following weekend, Shannon and I traveled to Steamboat Springs, CO for the Steamboat Stinger a 50-mile race where Shannon and I relay raced in the Co-ed Duo category.  Despite being a short 2-night trip, the fun we had made it worth the effort.  The course, while not technically challenging, has over 3500 feet of climbing per lap.  For this reason, it was the perfect course for my super light Pivot Les275.  The race went well, I felt really good, and after a cumulative 4.5+ hours of racing, I missed catching the third place team by 30 seconds.  We were still pretty psyched to finish 4th place in the competitive co-ed duo category.

 Finishing off my 25-mile lap

 Hangin' out at the MTBRaceNews tent post-race

Co-ed Duo podium

Next up was the Wasatch 360, a local 6-hour race that benefits Summit Bike Club, the junior development program I help coach.  Once again Shannon and I raced coed-duo.  Over the course of six hours, an epic battle brewed among the top three co-ed teams.  Despite my best effort, Shannon and I came up just short of the win, however the fun we had duking it out will make this one of our more memorable races of the year.

Eating an apple on the podium is probably poor form....but I was hungry!
Note:  Cutest podium girls ever!

The craziness continued with a long day volunteering at the Park City Point to Point and a trip to St. George.

I am now gearing up for my first solo 50miler this year, the Draper Fall Classic.  I raced this race in 2012 so I know what I am in store for which includes a long, but fun day of buffed out single track.

With the craziness of the past month, I admit that I have had some days of fatigue, however overall,  I feel really good.  I am most pleased that after a summer of inconsistecy, I put together two really strong back-to-back weekends of racing.

That said, I am looking forward to life slowing down a bit.....but first I am going to race my bike for 50 miles...