Adriamycin!!! What’s It DO???

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Though I talked very briefly some time ago about what the various chemotherapy drugs that my wife was treated with were “for”, I never really went into any kind of detail.

Now that chemo is “over”, I wanted to explore what some of the long-term and lasting effects of the treatment are. Because she reached that time – what with the odd numbing of her upper lip, the incision pains, swollen ankles and dry skin, I’d like to know which of those things is chemo-derived and which ones are not.

So we’ll g0 here next:

Adriamycin is the “second” drug of the cocktail she was force fed through the tubes and into her port every three weeks for six months. At first we called it the “red devil” because it WAS red and delivered in two, brat-thick syringes attached to the port tube. The nurse always came dressed in surgical gown, goggles, gloves and a mask – because getting Adriamycin on your skin could cause BLISTERING. (“And you’re injecting that into my wife because…”

This all came clear after research:

“In the 50s, an Italian research company was trying to find anticancer compounds from germs that live in the ground. They found one that was promising in an area surrounding the Castel del Monte, a 13th century castle. A germ that was related to the common “strep” bug and was bright red worked in trials against certain kinds of cancer tumors. Some French researchers discovered the same kind of compound that the strep germ made, so they combined the name of an ancient tribe that had lived near the castle and the French word for ruby red and came up with the name of the compound: Dauno-rubicin.

They tested it against leukemia (blood cancer) and lymphoma (lymph node cancer) and it worked – but they found that it also damage the heart.

They tried mutating it and they got another, related drug that worked as well, but wasn’t so damaging to the heart. They named this new compound Adriamycin, after the Adriatic Sea. The name was later changed to “doxorubicin” to conform to the established naming habits of the drug and chemical industry.

Adriamycin acts by jamming itself in between pieces of DNA in cancer cells. Any cell needs to make new DNA to make new cells. Adriamycin messes up the work of an enzyme that uncoils DNA so it can copy itself – it forces the DNA to stay open so it can’t close up and start splitting the cell to make new ones. The original cells age, then die, never having made any new baby cancer cells to continue the destruction of a human being.

But Adriamycin is DANGEROUS. Aside from the usual nausea, vomiting, and irregular heartbeats, it can also kill white blood cells (that’s why my wife got a Neulasta shot the day after chemo), as well as causing complete hair loss. “A more mild side effect is discoloration of the urine, which can turn bright red for up to 48 hours after dosing.” (My daughter wrote about this one in her first or second blog post, “Toxic Pee”: http://twenty.o-my-soul.net/?p=24). From a Georgia Tech manual for handling toxic compounds, we find this:

“Doxorubicin (trade name Adriamycin)…is a mutagen, carcinogen, and teratogen, and is highly irritating to the eyes, skin, mucous membranes and upper respiratory tract. Statistically significant…genetic damage have been reported in hospital pharmacists and nurses exposed to [it]. The toxic effects of doxorubicin may be experienced if swallowed, inhaled, ingested or exposed to the skin.”

Sheesh! No wonder the whole scenario creeped us out!

So besides slaughtering cancer cells, what’s the “rest of the story”? Grave indeed – “the risks of developing cardiac side effects…dramatically increase.” Doxorubicin makes the mitochondria (the place that makes the power to run a cell) in the heart muscles less able to make ATP – which is the energy used to run a cell: less energy, less strength for beating. Also, when Adriamycin reacts with the iron in blood, it can damage the heart cells, causing the fibers that tighten and loosen (making the heart beat) to disappear as well as eating holes in the cell’s jelly-like insides. Also, some patients may have weeping sores on the palms of the hand or soles of the feet, swelling, pain and a rash-like reddening of the skin – sometimes making the skin or hair a different color.

So there you go – a brief but chilling rundown of what THIS drug does to your beloved…

Image: http://upload.wikimedia.org/wikipedia/commons/thumb/e/ee/Doxorubicin%E2%80%93DNA_complex_1D12.png/220px-Doxorubicin%E2%80%93DNA_complex_1D12.png

“The Port’s Been Overrun!”

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

The port came out yesterday!

It was – and it WILL be! – a celebration for the next few days.

But there was a sobering note that sounded yesterday as well.

First, however, I’ll explain WHAT a port is.

When my wife chose to go with an aggressive regimen of chemotherapy (amazingly, I talked about neither!) she had to have a port installed so that they wouldn’t have to go vein diving with a sharp needle in her arm every time we came in for a chemo session.

“Port” is short for “portal catheter”, which is slightly shorter for “totally implantable venous access system”. You can see a picture of it above both “out and about” and implanted.

Because she was going to have six, six-hour-long sessions of continuous injection of the therapy drugs. I’ve copied the Wikipedia entry, then translated the long words into English so that they are understandable: “A port is a quarter-sized bowl with a flat bottom and a plastic bubble across the top like a drum head. A tiny tube leads out of the bottom of the bowl and that can be attached to thin tubes – one that goes up the neck (for blood samples) and one that goes into the heart (where you want the drugs to go).

“To put the port in, the doctors make a diagonal slit just above the collarbone and slide it in between the muscles and the skin. They put a couple stitches in the muscles to hold it in place then glue the cut with superglue and put a clear plastic band aid over it. It looks like a bump under the skin below a red scratch. You don’t have to do anything special to take care of it because it’s completely inside your skin, so swimming and taking a shower are not a problem.

“The bubble is made of a special self-sealing silicone rubber; it can be punctured hundreds of times without popping. To do chemo or to draw blood, someone will disinfect the area. Then they’ll poke the skin with a 90° Huber point needle and tape the whole thing down. The hole it makes will be so tiny that it will look like the person got a mosquito bite when they pull it out.”

The worst part is that my wife was able to FEEL the catheters all the time and they pulled when she turned her head.

That’s all done now!

The sobering part of the morning came while I was in the waiting room. The intern wheeling her into the surgery asked what her surgery was (they do that like a bazillion time before anyone even PICKS UP a scalpel!). When she said that it was a port removal, the intern got serious and asked, “Is that good news or bad?”

My wife replied, “Good news!”

The intern replied with a smile and the removal went on. When she related the story to me, I realized that there was an implied message in the first sober response. For some people, the removal of the port would be a surrender to the inevitable – the port is no longer useful and we might as well make the coming end as comfortable as possible.

I’m not sad; nor has the joy of the port coming out diminished at all. I simply now have more to be thankful for than ever before and I can hold up in prayer those whose ports are coming out because this is the end of the line…

Image: http://images.ookaboo.com/photo/s/PAC_met_Gripper_erin_s.jpg

Image: http://upload.wikimedia.org/wikipedia/commons/thumb/9/9f/Portkatheter_R%C3%B6ntgen.JPG/220px-Portkatheter_R%C3%B6ntgen.JPG

“Awareness” and Action

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…
I’ve read my daughter’s blog three or four times now (http://twenty.o-my-soul.net/). She started when we found out my wife has breast cancer, and while she hasn’t been as regular in posting as she’d wanted to be, what she lacks there she makes up for in introspection and impact.

Her current entry is about Breast Cancer Awareness Month.

I confess I did NOT join the Making Strides Against Breast Cancer (http://makingstrides.acsevents.org/site/TR?sid=16393&type=fr_informational&pg=informational&fr_id=36135) walk this weekend even though Cooper High School where I work has a team. The team captain commented to me yesterday that she was disappointed there weren’t more people walking with them (a subtle inquiry as to why I wasn’t…)

I did NOT sponsor anyone during the Susan B. Komen 3-Day For The Cure run/walk.

I did not donate to the American Cancer Society.

Why not?

I confess that there may be some anger in it; rebellion against “other people” horning in on “my” grief. I KNOW I felt an anger similar to my daughter’s when I see pink ribbons, pink football sweat towels, cleats, and wristbands. But for me, it’s a bit tempered with the thought that “at least they’re trying”.

As I point out above and more than once in this blog, men have trouble talking about breast cancer. Lots of guys have trouble talking about feelings in general with anyone but their intimates – nah, let me amend that. Guys have NO trouble talking about rage, anger, hate, respect and love…of beer, steak, exploding things, cars and “wimmin”. It’s the more subtle feelings they have trouble talking about. In fact, trying to express the more subtle feelings of love will shut down even the loudest most obnoxious guy – even me.

My guess is that the pink Capella Tower lights were a man’s idea. As were the pink-soled football cleats and sweat towel you see above on Minnesota Viking Antoine Winfield (26).

Interpreting these as a man, I think they are an attempt by men to talk about and support the women they know who have fought breast cancer. They may be clumsy and gauche, but hey, they’re trying.

And me? Why am I not at the front of the Cooper squad making Strides Against Breast Cancer? Why am I not riding in the Breast Cancer Ride on August 4-5, 2012 when I rode and walked against diabetes four time?

Maybe I’m angry. Maybe “awareness” isn’t enough. I’m certainly “aware” of breast cancer now; intimately so. Maybe I just don’t know what to do and I haven’t found a way to really make a difference and until I do, I’m going to write this blog and nod pleasantly when people try…and try and figure out how I could make my writing into a weapon against breast cancer so that people like my wife and the wife of my science fiction writer friend wouldn’t have to suffer any more.

Image: http://bloximages.newyork1.vip.townnews.com/phillyburbs.com/content/tncms/assets/v3/editorial/a/62/a6252675-4a7a-5780-85ed-2cfa3dd8c8fa/4e90c82f974f5.preview-300.jpg

Taxotere!!!! What’s It DO???

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Though I talked very briefly some time ago about what the various chemotherapy drugs that my wife was treated with were “for”, I never really went into any kind of detail.

Now that chemo is “over”, I wanted to explore what some of the long-term and lasting effects of the treatment are. Because she reached that time – what with the odd numbing of her upper lip, the incision pains, swollen ankles and dry skin, I’d like to know which of those things is chemo-derived and which ones are not.

So we’ll start here:

Taxotere: (This is the “brand name” drug, its generic name is docetaxel) anti-mitotic chemotherapy medication (that is, it interferes with cell division). This is the “simple” answer I gave on May 7 (http://breastcancerreaper.blogspot.com/2011/05/bust-drug.html). But what exactly does it do and does it have long-term side-effects and any OTHER impact on the Human body?

From: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000987/#

“You may have a higher risk of developing certain serious side effects such as low levels of certain types of blood cells, severe mouth sores, severe skin reactions, and death. Docetaxel injection may cause low levels of white blood cells in the blood…fever, chills, sore throat, or other signs of infection…serious or life-threatening fluid retention. Fluid retention does not usually start immediately, and most commonly occurs around the fifth dosing cycle. If you experience any of the following symptoms, call your doctor immediately: swelling of the hands, feet, ankles, or lower legs; weight gain; shortness of breath; chest pain;cough; hiccups; rapid breathing; fainting; lightheadedness; swelling of the stomach area; pale, grayish skin; or pounding heartbeat…nausea, vomiting, diarrhea, constipation, changes in taste, extreme tiredness, muscle, joint, or bone pain, hair loss, nail changes, increased eye tearing, sores in the mouth and throat, redness, dryness, or swelling at the site where the medication was injected, blistering skin, numbness, tingling, or burning sensation in the hands or feet, weakness in the hands and feet, unusual bleeding or bruising, nosebleeds.”

OK – yes to some of those, no to lots of them.

From Wikipedia Taxotere:

“Docetaxel is partly-synthetic copy of Taxol, an extract from the bark of the rare Pacific yew tree. Due to scarcity of the tree, Taxotere was extracted from the common European yew tree.”

“Docetaxel is a white powder and is the active ingredient in Taxotere. The solution is a clear brown-yellow…a single dose contains ethanol, saline, sodium chloride or glucose for administration plus polysorbate 80…vials may be stored for 24 months below 25°C away from light.”

“The cell-killing activity of docetaxel promotes and stabilizes microtubule assembly (microtubules make up the cell structure called a “spindle” – it’s that happens when cells divide. It also prevents microtubule disassembly in the absence of GTP. This leads to a significant decrease in free tubulin, needed for microtubule formation and results in inhibition of mitotic cell division between metaphase and anaphase, preventing further cancer cells from forming. Because microtubules do not disassemble in the presence of docetaxel, they accumulate inside the cell and cause initiation of cell suicide (apoptosis).”

“Docetaxel is a chemotherapy drug and is a cell killing compound and so is effectively a biologically damaging drug...docetaxel is toxic to all dividing cells in the body. This includes tumour cells as well as hair follicles, bone marrow and other germ cells.”

From: http://www.cancersupportivecare.com/late.html

“Long-term effects are side effects or complications of therapy that persist when therapy is completed, requiring patients to develop compensatory treatment programs to relieve or control these side effects…chemotherapy can cause damage to vital organs, such as heart, lungs, kidneys, and the gastrointestinal tract. Older persons over 65 and 70 may have pre-existing heart, lung, kidney, gastrointestinal, or liver problems, which can be accentuated with anti-cancer therapy, as these organs may be more susceptible to side effects from treatment.

Peripheral neuropathy, for example, pain, numbness, tingling, loss of sensation or heat/cold sensitivity in extremities or body, is often a side effect for patients receiving Taxotere...”

From: http://www.caring.com/questions/taxotere-side-effects

“Melanie Haiken, (Caring.com senior editor) notes: Taxotere (brand name Taxol) has many of the same side effects of other chemo drugs, but some are better than others, some are worse…taxotere caused a lot of bone pain and muscle aches. Some say their arms and legs ache, while others say the pain is worst in the neck, back, and shoulders; neuropathy, or nerve damage, which makes feet and hands feel tingly or numb…The good news is that taxotere seems to cause less nausea for many cancer patients than other chemo drugs, such as the A/C it often follows. Hair loss may also be less of a problem…Side effects are very individual, and they also vary according to dosage.”

So, we’re still on the journey and while I by no means “understand” what’s been going on, others have and there are places to find information.

Keep looking; keep learning!

Image: http://w ww.emc.maricopa.edu/faculty/farabee/biobk/spindle.gif

Strange Pains and Feelings

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

I honestly thought the “pain” part was over once chemotherapy was done.

I don’t know for sure about my wife, but for some reason I thought that once the drugs had cleared her system, life would become a bed of roses. I thought the swelling ankles, aches, pains and wooziness and other symptoms we’d come to expect with chemo would be gone.

Then a few weeks ago, there was “the fever”. This happened during chemo, so we weren’t exactly surprised and I blogged about it here: http://breastcancerreaper.blogspot.com/2011/08/real-poop.html. There’ve been other aches and pains – at least I know about the ones she TALKS about – but nothing really serious.

Yesterday, she came home with chest pains – NOT THOSE KIND OF CHEST PAINS! – and we’ve been talking about it. I (of course) did some research and found the following:

“According to the University of Florida, the cut nerves can also cause shooting pains soon after surgery, and dull aching or burning pains for up to a year. The nerve pain will subside with time, and any pain can be treated with medication in the interim. The nervous system has a limited ability to repair itself following damage, and the numbness in the skin may persist for long after surgery.” (http://www.livestrong.com/article/113850-breast-mastectomy-complications/#ixzz1ZWy5RMZc)

I was aware that nerves grow slowly. That is a standard teaching to ALL biology students and an area of continued research in medicine. In fact, there’s still work being done on nerve regeneration and even to find out how to make limbs regrow themselves – a theme from an old book my master storyteller, Madeleine L’Engle called THE ARM OF THE STARFISH. Logic leads me to realize that growing nerves might just hurt.

However, I also found this: “Since mastectomy…I have muscle spasms in the pectoral muscle and pain along the incision area…I have a constant squeezing like a boa constrictor squeezing under my ribcage area and it goes around my entire body. [A couple of doctors respond] At the time of the mastectomy, the surgery extends down to the base of the breast, including the covering of the pectoralis muscle there. Many women…notice increased sensitivity at the ribcage after mastectomy…It's also common to see sensitivity at the rib with age with anyone. This is something called costochondritis.” (http://www.breastcancer.org/treatment/planning/ask_expert/2008_05/question_07.jsp)

As well, my wife realized that she’s been lifting things lately – likes tables, chairs and sometimes grandsons! It’s not something she’s been doing for the past seven months and she’s realized that it MAY just be the type of ache that comes from bringing yourself up to speed after a long break from exercise – so we relax a bit, keep a close watch on the condition and continue on…

image: http://image.shutterstock.com/display_pic_with_logo/270058/270058,1264070046,1/stock-photo-senior-woman-taking-a-break-after-doing-exercise-44980528.jpg