The cellular warfare of Chemotherapy

Why do I feel like I should be singing Pat Benatar’s Love is a Battlefield as I write this blog entry?

This post is dedicated to my chemical warefare …

Doxorubicin – Adriamycin – Red Devil is the first chemotherapy drug in my regimen. It stops the growth of cells by blocking an enzyme called topoisomerase II that cancer cells need to divide and grow.  When DNA splits, it’s somewhat like pulling yarn apart … if you are splitting the yarn from one end and holding onto the other end, it eventually gets tightly coiled on one end.  Topoisomerase II  cuts the two strands of DNA, releases the tension in the coil, and rebinds them.

The red devil stops the DNA from replicating … in all fast-growing cells.  So that is why my hair falls out while my cancerous cells die.  Any fast growing cell – hair, mouth, cancer – has it’s DNA damaged and self-destructs.

This drug is so potently toxic that it is administered by hand so the nurse can ensure it’s getting into my vein.  If it escapes … tissue damage … but what about my veins and heart?!  I can only have so much Doxorubicin over my lifetime.  I now have a chemo expiry date.

The limit lifetime cumulative dose to <550 mg/m² to reduce risk of cardiotox.  I’ve had ~240 mg/m² so that means if I get ONE reoccurance of cancer – ANY cancer that is treated by Doxorubicin – I am pretty much done.  My breast cancer will head for my breasts, bones, brain, lung or liver (all of which are treated by the Red Devil.

What Doxorubicin Is Used For:

  • Acute lymphoblastic leukemia (ALL)
  • Acute myeloblastic leukemia (AML)
  • Bone sarcoma
  • Breast cancer
  • Endometrial cancer
  • Gastric cancer
  • Head and neck cancer
  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma
  • Liver cancer
  • Kidney cancer
  • Multiple myeloma
  • Neuroblastoma
  • Ovarian cancer
  • Small Cell Lung cancer
  • Soft tissue sarcoma
  • Thyomas
  • Thyroid cancer
  • Transitional cell bladder cancer
  • Uterine sarcoma
  • Wilms’ tumor
  • Waldenström macroglobulinemia

The nurses who administer this drug hate the nickname Red Devil … they want me to think of all the wonderous good it is doing.  I have one less cancerous cell in my body (if any).  And I do try … when Andrew* wished me well this morning with “Hope you feel horrible today because that means the drugs are working”, I took it as a compliment.

As I said before … It’s like living my own scifi where my body is in stasis – not dead but not recreating … then it is jolted back into living later in the chemo cycle.  Am I being reincarnated every time?  Or am I just using up my nine lives?  Meow.

IMG_1143
The Red Devil

Let’s look at some of the more serious side effects … from Chemocare on Doxorubicin:

A serious, but uncommon side effect of Doxorubicin is a decrease in the heart’s pumping capability. Therefore, there is a lifetime maximum on the amount of doxorubicin you can receive. This “lifetime maximum dose” may be lower if you have heart disease risk factors such as radiation to the chest, advancing age, and use of other heart-toxic drugs. Your doctor will check your heart function (with an ECHO test) before you may take any Doxorubicin and will monitor your heart closely during your treatment. Dose-related heart problems can occur as late as 7 or 8 years after treatments have ended.

Another rare, yet serious risk that is associated with doxorubicin therapy is the risk of developing a blood cancer, such as leukemia, up to years after taking the drug. Talk to your doctor about this risk.

Tumor lysis syndrome may occur as a result of treatment with Doxorubicin. Tumor lysis syndrome occurs when large amounts of cancerous cells are rapidly killed by the therapy. Tumor lysis syndrome can lead to kidney failure and other sudden health problems. Tumor lysis syndrome usually occurs within 24 – 48 hours of therapy.

Isn’t that lovely?!  I will feel like a ticking timebomb for 8-10 years … well past my 5 year cancer free anniversary!

Cyclophosphamide – Cytoxan – The White Drip is the second chemotherapy drug I receive right after the Adriamycin.  It’s called an alkylating agent, which reacts with the proteins that form the delicate double helix structure of a DNA molecule.  An alkyl group is added and the DNA is damaged and self-destructs.  It is administered via IV pump to my PICC line.  I usually have to unplug myself and wander to the bathroom to pee red devil sometime during this treatment.

It is also a potent immunosuppressant to decrease my immune system’s response.

It’s all good … If I was alive and kicking with cancer in the WWI era, the doctors would be injecting me with mustard gas.

May 2 Chemo Lounge

Before I go for my chemotherapy infusion, I have to take three drugs:

  • Emend
  • Ondansetron
  • Dexamethasone

Chemo aftercocktail

Emend works by inhibiting a protein receptor on my central nervous system.  It basically is the party pooper who tells everyone to shut up and go to bed … nothing to see here.  It won’t allow my nervous system to get agitated over the chemo bomb and inhibits my nausea. I take it for Day 1, 2 & 3.

Ondansetron works in my brain by blocking serotonin.

Vomiting is controlled in the brain’s vomiting centre. The vomiting centre is responsible for causing feelings of sickness (nausea) and for the vomiting reflex. It is activated when it receives nerve messages from the chemoreceptor trigger zone (CTZ) area of the brain and when it receives nerve messages from the digestive system.

Chemotherapy can cause a substance called serotonin (5HT) to be released in my gut. This 5HT acts on the 5HT3 receptors that are found in the digestive system and causes nerve messages to be sent to the vomiting centre.  It stops all that.  So being sick is all in my head … And makes me wonder about the gut/mind link and how food makes you happy … more on that thought later.  I have to dig up my cleanse/detox/fasting notes.

Dexamethasone is an anti-inflammatory steroid that will trick my immune system into not responding, treat my nausea and make me hungry.

I have another anti-nausea drug to take at the first signs of nausea.  The pharmacy consultant told me not to wait but to get ahead of the wave … so I take one of these almost every 6 hours for Day 2 to Day 4 … tapering off Day 5 or 6.  I also take OTC Gravol with this to really quell the queasies.

  • Prochloperazine

24-hours after my chemo infusion, I have to get jabbed with Neulasta.

Neulasta

Neulasta kick starts my bones into generating those neutrophils (white blood cells) to fight infection.  I had none … which is why I ended up in Emerg and being admitted to the Oncology Ward after Chemo 1 in my Visiting Hours docu-drama.

I was supposed to call home care to watch me do the first self injection … but #chemobrain forgot.  Having asked a nurse to show me, and watched them inject my belly with Neupogen (daily injection vs Neulasta’s weekly) and anti-clotting Heparin … I felt I could deal with the subcutaneous (under the skin) injection.  And just to make sure I didn’t forget a step like swabbing myself with rubbing alcohol, I googled it on YouTube and found a video to show me how … yes, my GP did shake her head and say “You can find anything on YouTube”

Heparin and Warfarin are related anti-clotting drugs.  Warfarin was first used as rat poison … and I was getting injected daily with Heparin while admitted.  At least until I said “Nope. I am going to run laps in the Oncology Ward.”

I didn’t see any rats.

All of this chemical warfare makes me very, very, very, VERY lethargic and nauseous.

The exhaustion is like nothing else … that drugged and foggy feeling that you will narcoleptically sleep anywhere your head drops.  Deep exhaustion that permeates every cell – every tissue – every bone.

I lay in bed contemplating how to get up to pee, because I didn’t have the strength to get up from under the 10,000kg truck on top of me.  But since I wash the sheets and have to sleep in that bed, I managed to get up and crawl to the ensuite bathroom.

The Catch-22 is that I have to drink 2 to 4 litres of water to flush the toxic chemo and dead cells from my body.  So I can’t shrivel up and not pee.

I can’t stay awake.  But I still need sleeping pills to sleep through the night.

The nausea has been a constant rollercoaster in the background.  I have not yet vomited from the chemotherapy, but did vomit due to my febrile neutropenia.

My appetite goes from the Day 1 steroid binge to Day 3 where I can usually only stomach one plain food item.  For Chemo 1 that was english muffins (carbs!) and for Chemo 2 it is plain greek yogurt (protein!) and unsweetened applesauce.

I can’t even handle strawberries.  I had a bowl of fresh strawberries after Chemo 1 and could barely eat them.  The smell … the flavours … the texture … all seemed enhanced 1000x.  Overload!

Hopefully by Day 6 … 7 … 8 I will be feeling somewhat normal and be able to do things that I need to do.  Like socialize.

Aside from my chemo cocktails, I take OTC Tylenol (cancer and chemo are fucking headaches), Gravol (queasies), Benedryl (allergic to bandages and maybe latex), and my litany of anti-anxiety, anti-depressants and sleeping pills.  And thyroid pills.

I need to understand the link between Hashimoto’s (autoimmune hypothyroid) and TNBC (Triple Negative Breast Cancer).

And what do you think all of this costs?  I am estimating $15k to $20k CAD … per chemo cycle!  And that is just the drugs.  Not the cancer centre/oncologist/nurses/medical supplies costs.

Fighting cancer one cell at a time,

Lisa

*Name(s) changed to protect the guilty.

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