Easy Chemo

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EASY CHEMO

Many of us in CancerLand use the term "easy" to describe certain chemos.   "Oh, that's an easy chemo, you'll like that one" I've said to a cancer buddy, without realizing that statement may sound slightly insane to the healthy hipster sitting next to me at the Starbucks.   You normal folks probably don't even realize there are dozens of classes of chemotherapy drugs, all which work in different ways on your cells.

For those of you who haven't followed this blog from the beginning, let me explain and save you about 50,000 words:  if you are a Breast Cancer Stage IV lottery winner, your prize is treatment.

Forever.

Yay.

It never stops. There are no "six rounds of chemo and you are done" like with the earlier stages.   Early stage women get a few rounds of adjuvent chemo for the purpose of killing any microscopic cells that may be floating around.  In some of us, that didn't work, and so we end up with unsurvivable cancers.  We get palliative chemo, which means they are no longer trying to cure us, just give us symptom relief, maybe put us into temporary remission, or slow the cancer down and give us a longer life.  If none of that happens with one treatment, and the cancer progresses while on it, than we try something new, but we never stop.

Stage IV breast cancer, like cockroaches, cannot be killed, only controlled with poison, and not for long depending on where the cancer ends up.  Since mine's in the liver, my life expectancy was 3 years, and I've already lived 2.

Not that I'm counting.

If you are newly diagnosed with Stage IV, you may start with the easier hormonals.  It may be in pills or a shot, and they have their own side effects, but they are not chemotherapy. (A lot of people think chemotherapy is anything "chemical" you put in your body but that statement is archaic.)  Chemo drugs are a specific class of drugs that do specific, cytotoxic things.  Eventually, inevitably, that early treatment will fail, as that is the nature of Stage IV breast cancer.

Then it's on to Chemo for Life, which, by the way, would be a great name for a rock band.  You try one until it fails, and you try another until it fails and so on.  I am on my seventh chemo.  You hope that one will work for a time and you can stick with it.  Maybe it'll shrink your tumors enough so you can take a little break that won't be too dangerous and allow your cancer to pop back up like wildflowers in the spring.  But, make no mistake - you will never be off chemo for long.  In Stage IV world, you just keep checking off the chemo list until there are no more to try, and then you look into clinical trials and then you call hospice.

Then your lottery ticket blows into the wind.

Here is a list of the chemos I've been on:  Carboplatin, Taxotere, Taxol, Abraxane, Navelbine, Halavan, and Gemzar.

Ah, but that is not all.  I am on other anti-cancer drugs that are infused but which are not chemotherapy drugs: Herceptin, Zometa and now Perjeta.  Herceptin and Perjeta are for my specific type of cancer, and Zometa is to keep my bones strong.

Sounds like a bunch of comic book characters, doesn't it?

In a windy city, on a desolate planet, Carboplatin came to the rescue, scooping up Ms. Abraxane and the magical Gemzar and flying off to Navelbine in the hopes that the evil Halaven wouldn't find them in their lair.

So, now that the background is done:  what's an Easy Chemo?

1.  An Easy Chemo is one that doesn't have you praying to the porcelain gods, saying hi to Ralph or calling Earl.  It is also one that doesn't force you to take a zillion expensive drugs to prevent those colorful barfing metaphors.  As an example of expensive, the anti-nausea infusion that works best for me, Aloxi, costs $1400 a dose, which by the way, I get weekly.  Or used to, as it became too expensive for my insurance.  Now I get a less effective one called Kytril.   To make up for what Kytril doesn't do, and because my latest chemo seems to cause nausea, I just got a new prescription for an anti-nausea drug called Emend, which has a $50.00 copay - for three pills.

Three.

You can do the math better than I can, but 180 oxycontin only costs five bucks.  It seems it's a lot cheaper to control pain than to control puking.

Let's just say that I have cleaned my toilet in preparation.

2.  An Easy Chemo is one in which you get to keep your hair. Healthy people, listen up:  Not all chemos cause hair loss.  In fact, most do not.  If you see somebody who is in cancer treatment and they have their hair, don't assume anything based on that.  Don't imagine that they are feeling good and don't assume they are lying about being in treatment.  You may assume that their hair looks bad because it fell out and grew back in weird, because (ahem) that does happen.  I used to have long, wavy hair.  Now it's short and stick straight except for the back of the neck, where it is not only curly, but looks and feels like a brillo pad. We won't even talk about the color.  The truth is, once you have entered Stage IV World, many chemos you try won't take your hair, but trust me when I say we'll never have long hair again.  Whether it falls out or not,  chemotherapy of any kind is not good for growing hair and it's not likely to grow long and luxurious while we are on it.

And remember, we are always on it.

Here's a funny story, at least funny if you are a morbid cancer patient such as myself.  One of my nurses just told me about a woman she treated who had just died of breast cancer.  She thought I might have known the woman, but was not sure we'd gotten treatment at the same time, and I wasn't remembering her name.  So the nurse described her as "a woman with short spiky hair..."  Um.  That pretty much describes every breast cancer patient in existence. Anyway, I saw her obit in the paper, and I didn't know her,  but I am still sad she died.  She was my age.

An Easy Chemo is one that doesn't make your getting out of bed more difficult than getting your teenage son off facebook.  Cancer makes you tired. Chemo makes you tired. Together they make a tiredness bomb, only one too tired to go off, so it just sort of lays there, fizzling.   Some chemos make you more tired than others.

Cancer tiredness is not like healthy people tiredness.  There is no sleep I can get, no nap I can take, no rest I can do that will refresh me.  I am deeply exhausted, all the time.   I wake up in the morning (noon), make my espresso coffee, and immediately need to sleep for several more hours.   I would sleep all day if it wasn't for ritalin, which I asked for when I started Halaven, a very tiring chemo for me.

Ritalin only allows me to keep my eyes open, it doesn't give me energy to do things.  Sometimes, even nagging my husband is hard.  But if I didn't, he'd think I was already dead.

An Easy Chemo is one that doesn't leave your bones feeling like your dog has chewed them.  Once you are into your third year of straight chemo, as I am, your bones are pretty much always going to ache like a chef scooped the marrow out for his fancy gourmet dish, but it is a matter of degree.  Some chemos can leave your bones aching like you are Rihanna and Chris Brown played the drums on you, while others just leave you with a dull ache like you you have the flu.  The main question is:  One oxy or three?

An Easy Chemo is one that doesn't leave your skin looking like a 13 year old girl whose mom is in denial of her child's puberty and won't buy her any Stridex.  Yes, I am in my 50s and my nickname could be pizza face.

I read an unintentionally hilarious article on Oprah's website by a Hollywood Writer with Cancer about "tips for getting through chemo" that said, "chemo is better than Botox and takes all the toxins out of your skin.  Suddenly your face is as smooth as a baby's butt."

Hah!  No.  It is not better than botox (which, my dear Hollywood writer, puts toxins in your skin, as does chemo) and even without break-outs, my skin is not as smooth as a baby's butt; it's as wrinkled as time, and I bet I've done a thousand times more chemo you. (But probably not as much botox.)  According to her theory, I should look like a fetus's butt.

But wait.  A pre-born baby butt is pretty wrinkly so I guess I do.

Even worse, there are some chemos that cause "hand and foot syndrome" in which the skin on the soles of your feet and palms become red, peeling, and very painful (because the toxic chemo leaks from your capillaries into your skin, Ms. Hollywood Writer).  In the worst case, your hands and feet become almost unusable, which would be absolutely horrible if we weren't so tired we didn't really do anything anyway.

An Easy Chemo leaves your fingernails alone.  By that I don't mean you can actually grow them strong, or put polish or gel on them with any hopes of it lasting or anything, that is just dreaming too big.  My nails are weak, easily broken, and now ridged.  I only put polish on for very special occasions and hope it lasts a couple of hours before chipping off and taking half my nails with it.  But, a good chemo won't leave your fingernails turning black and falling off into your salad.  Fortunately, that usually only happens with early stagers, as they tend to be more gentle in dosing with us palliative care folks - but not always.

An Easy Chemo doesn't kill your blood.  All chemos will affect your white count, lowering it and leaving you as open to infection as Beyonce's legs on Super Bowl Sunday,  but some lower it less than others.  Some require the dreaded colony stimulator drug such as Leukine or Neulasta to keep you with an immune system.  Drugs, by the way, I will no longer take, even if that limits my chemo choices. Some chemos though, don't mess with your blood too much. For me, those were Abraxane and Halavan.

A few chemos will also affect your red count, leaving you dangerously anemic and necessitating a blood transfusion (Navelbine for me).  I know that's considered A Bad Thing, but I loved having a blood transfusion and dream of the day I can have one again.  It was seriously energizing, like crack for cancer patients.

An Easy Chemo doesn't cause neuropathy.  Some chemos cause nerve changes and some don't.  You can feel it almost immediately - your fingertips and toes suddenly feel more sensitive, or like they are burned or tingling.  Sometimes it goes away and sometimes it does not.  A good remedy is l-glutamine but you need to be able to put the dissolved powder into full glass of water and drink it four to six times a day, and I no longer can do that.  I sip water, but can't do large glasses or put a lot large amounts of anything in my stomach as it hurts too much.

An Easy Chemo doesn't make you constipated.   Just kidding.  All chemos make you constipated.

An Easy Chemo doesn't cause heartburn.  Some chemos can cause your esophagus to feel like it is made from a burning hot poker that was dipped into the fiery pits of hell.  Some can cause you to puke acid in the middle of the night while you are sound asleep, waking you in a terrible way as well as leaving your upper intestinal track burned.  No, I am not kidding.  Heartburn can be dealt with using medication, but many of those medications (specifically proton pump inhibitors like Tagamet) can't be taken by a person who had c-diff.  Like me.   So if Tums doesn't cure it, I'm SOL.

So, back to Starbucks.  You might think that when I say something was an "Easy Chemo" that I mean none of these side effects appear.   You couldn't be more wrong. An Easy Chemo might only give you 3 or 4 of them. It is up to you to decide which 3 or 4 make for your own personalized Easy Chemo.  For me, ones that don't mess with my blood,  give me heartburn or intense nausea, or cause me to lose my hair are the Easy Chemos.

I'm currently on Gemzar.  It is not an easy chemo.  I have hair but I am nauseated, have major gastro problems, it wreaks havoc with my blood,  and can barely stay awake even with double-doses of ritalin.

I wrote some chemo survival tips when I was newly diagnosed.   I stand by those tips, but it is really only for those who are doing adjuvent, curative chemo for early stage cancer, as I was then.  I'm too sick to follow any of those tips now.   For those of us on palliative chemo, it is an entirely different ball game, with different rules.  Well, really one rule:

Do it or die.

If you are Stage IV, here is hoping that whatever chemo you may be put on is an Easy Chemo.  More importantly, here's hoping that it puts you into remission, even for a little while.
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