ENCORE #105! – Cytoxan!!! 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…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in November of 2011.

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:

Cytoxan is the “third” drug of the cocktail she was force fed through the tubes and into her port every three weeks for six months. “Cytoxan is a cyclophosphamide that has been converted into a non-toxic ‘transport form’. This transport form is a ‘pro-drug’, subsequently actively transported into the cancer cells. Once in the cells, enzymes convert the drug into the active, toxic form that kills the cancer cell.”

Plain English, please!

OK – first stunning surprise is that Cytoxan is a cytotoxic chemotherapy agent similar to mustard gas.

Although used today as anti-cancer drugs, they can theoretically also be used for chemical warfare. Nitrogen mustards add chlorine atoms to the DNA of cancer cells, in effect poisoning the cancer cell.

Mustard gas was stockpiled by several nations during the Second World War, but it was never used in combat. Mustard gas and its related compounds are strong and long-lasting blister agents. Production and use is restricted.

How did we get from WWII mustard gas to anti-breast cancer drugs? During WWII nitrogen mustard gases were studied at Yale University and classified human clinical trials of nitrogen mustards for the treatment of cancer started in December 1942. Also during WWII, an incident during the air raid on Bari, Italy led to the release of mustard gas that affected several hundred soldiers and civilians. Medical examination of the survivors showed a decreased number of white blood cells. After WWII was over, the Bari incident and a Yale study came together prompting a search for other similar compounds. The nitrogen mustard became the first chemotherapy drug mustine.

Many people taking cytoxan do have serious side effects. Side-effects life nausea, vomit, bone marrow suppression, stomach ache, diarrhea, darkening of the skin/nails, hair loss or thinning of hair, changes in color and texture of the hair, and lethargy. Cytoxan can cause cancer, it can lower the body's ability to fight an infection as well as an unusual decrease in the amount of urine, mouth sores, unusual tiredness or weakness, joint pain, easy bruising/bleeding, existing wounds that are slow healing.

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

Encouragement (In Suffering, Pain, and Witnessing Both…) #6: And Then There’s Peace…

The older I get, the more suffering and pain I’ve experienced; and the more of both I stand witness to. From my wife’s (and many, many of our friends and coworkers) battle against breast cancer; to my dad’s (and the parents of many of our friends and coworkers) process as he fades away as this complex disease breaks the connections between more and more memories, I have become not only frustrated with suffering, pain, and having to watch both, I have been witness to the suffering and pain among the students I serve as a school counselor. I have become angry and sometimes paralyzed. This is my attempt to lift myself from the occasional stifling grief that darkens my days…

If you skim this blog, you know that my dad died a bit over a month ago of…while not precisely complications of Alzheimer’s, then a series of events precipitated by his Alzheimer’s symptoms.

I guess it’s hard for me to say that Dad “died of Alzheimer’s, because it’s not a “deadly disease” like measles or breast cancer or bubonic plague or influenza. The end result was the same no matter what.

During the years-long experience – I started my Alzheimer’s portion of this blog in September of 2016 – I learned a lot and I felt a lot. I learned the language of Alzheimer’s and how others treated people with Alzheimer’s.

But perhaps the hardest part for me was watching my dad’s personality drain away. At his funeral, people at the gathering repeatedly mentioned that my dad “liked to have a good time”. A few people shared stories and everyone there was able to imagine ANOTHER instance where it was obvious that he enjoyed life and enjoyed enhancing it with sports – both playing and watching, as well as hosting and going to parties. The parties started when he met my mother! That’s a lot of years of parties!

By the time he passed on February 4, 2019, we were lucky if he spoke while we were sitting with him in his apartment for an hour – and this was before he had his stroke. He was often virtually silent when I went to spend short periods of time with him several times a week. He seemed distant, not intentionally, but because he simply seemed to be living in a moment and didn’t see much reason to comment on anything that he’d already commented on over the previous 87 years.

That was hard until I learned to just sit. Just “be” as the Mindfulness people say. When I quit fretting; quit enumerating the things I “had to do”, I started enjoying my time with him more; not because of the sparkling conversation, or physical humor, or streams of jokes (THAT’S how I deal with one of my brothers), but just sitting with him. Sometimes we didn’t talk for the entire time, only occasionally looking at each other, usually with a TV on between us, but sometimes in silence. We never did do music, except for when the recreational director led singing or we went to a concert together in the second floor theater. Then he’d sing and laugh and clap.

When he did pass away, I was at peace with it. Of course I missed him, but I felt as if I’d spent “quality time” with him as we sat in his dimly lit, very warm apartment. It’s hard to understand now, but this period of simply sitting with him came out of an article I commented on here, https://breastcancerreaper.blogspot.com/2018/11/guys-gotta-talk-aboutalzheimers-20-what.html

Dad’s reality was very different from mine. He was sometimes frustrated because, as an active man, he’d rarely stay in one place, let alone sit still. But as Alzheimer’s progressed, he slowed down – not by choice, but because his brain wasn’t functioning at peak efficiency. But slowing down sometimes offers us a chance to see the world from a different perspective; again, he didn’t WANT this, but it was his reality and it was slower than the one he’d spent his first 85 years in. Though it frustrated him, it gave me a glimpse into what it would be like to slow down a bit for myself. I’ve taken to sitting by our fireplace more often now, sometimes even in the morning before I go to work.

He’s at peace now, but I think he imparted a little bit of that peace to me even before he passed away. I’d like to continue to cultivate that sense as I grow older, myself.

Job 5: 23 says, “For you will be in league with the stones of the field, And the beasts of the field will be at peace with you.”

Image: http://www.quoteambition.com/wp-content/uploads/2017/04/encourage-quotes-destiny.jpg

ENCORE #105! – Taxotere!!!! But 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…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in October 2011.

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: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

ALZHEIMER’S RESEARCH RIGHT NOW! #2: Adorable Hamsters May Hold Key To Curing Alzheimer’s!!!!

From the first moment I discovered my dad had been diagnosed with Alzheimer’s, it seemed like I was alone in this ugly place. Even ones who had loved ones suffering in this way; even though people TALKED about the disease, it felt for me like they did little more than mumble about the experience. Not one to shut up for any known reason, I added a section to this blog…

Every month, I’ll be highlighting Alzheimer’s research that is going on RIGHT NOW! Harvested from different websites, journals and podcasts, I’ll translate them into understandable English and share them with you. Today: https://www.sciencedaily.com/releases/2019/02/190206104607.htm

“When hamsters and other small mammals hibernate, their brains undergo structural and metabolic changes to help neurons survive low temperatures. A key event in this process appears to be the phosphorylation of a protein called tau, which has been implicated in AD. In the brains of hibernating animals, phosphorylated tau can form tangled structures similar to those seen in AD patients. However, the structures disappear and tau phosphorylation is rapidly and fully reversed when the hibernating animal wakes up.”

This article caught my eye because I’ve always been fascinated by the idea of “cold sleep”. Many science fiction stories use it as a possible way for Humans to travel interplanetary or interstellar distances and awake at their destination barely aged from the moment they were placed in it.

Notable examples of the idea are the Star Trek Original Series episode, “Space Seed”, in which Ricardo Montalban and his genetically altered cronies – who had, incidentally, attempted to take over all the governments on Earth and were arrested, tried, and exiled from Earth. Packed into the slow starship, BOTANY BAY, they were shot into space prior to the invention of warp drive and discovered by the USS Enterprise and reawakened. Various tense situations ensued until the crew of the Enterprise sent them, refrozen, on their way to a colony world called Ceti Alpha V…

A more recent example of using “cold sleep” or “suspended animation” is the 2016 film, “Passengers” in which the gorgeous Jennifer Lawrence and the dashing Christopher Pratt are colonists on a “sleeper ship” voyage that will take some 120 years to complete. Something goes wrong, and Pratt wakes up alone. He lasts a year, then wakes Lawrence up and after much angst, the Avalon really malfunctions and they have to save the crew and passengers (5256 of them).

Research continues into the idea of suspended animation, and scientists have even discovered that weird little creatures called tardigrades or “water bears” can actually form something called “living glass” (https://www.sciencealert.com/we-can-now-harness-the-tardigrade-s-strangest-superpower-and-give-it-to-other-organisms) and can be revived from this state decades later.

At any rate, the hamster brains form the dreaded tau proteins, which, along with plaques, are believed to be the major components causing Alzheimer’s. The thing is that, when the hamster awaken, the tau proteins vanish…

Why is that? The chemistry of the hamster’s brains change dramatically, some 337 new chemicals flood it that are different from those in a normally functioning (Siberian hamster) brain. “The largest change for any metabolite -- about 5-fold more in hibernating animals compared with control animals -- was for phosphatidic acid, which is known to activate an enzyme that phosphorylates tau.” IOW, the tau proteins that create the plaques in THEIR brains (and the plaques are very similar to the ones that form in the brain of our beloved family members who suffer from Alzheimer’s) VANISH once the cutie fuzzball wakes up! So there’s something in the hamster brain that changes the protein back into its former benign nature.

What does this mean for our parents or for others who are just now discovering that they may be in the early stages of Alzheimer’s?

It’s just one more bit of hope to hold out to those who are just beginning this long – and for me and my family – recently completed journey.

Image: http://static.premiersite.co.uk/38792/img/38792_6475425.jpg

ENCORE #104! – Checkpoint Inhibitors – Using the Cancer Victim’s Body To Fight Back

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…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in February 2016.

Doctors have known about checkpoint inhibitors for years, but when dealing with cancer and the action and reaction of the body at the CELL level, it takes time and effort to understand what is happening.

For starters, we all know that cancer cells are ones that have started to grow uncontrollably, creating a tumor. There are over a hundred different cancers that affect the human body. Many of these can cause breast cancer. Even within the types that cause breast cancer, there are other, even more specific types – it’s like saying that you have DOGS. Within that kind of mammal, there are many kinds of dogs. If you choose one type, say Retrievers, you have black labs, chocolate labs, and golden labs t0 name a few. Breast cancer is like that.

What every cancer cell of any type has in common with every other type, is the ability to fool the body into thinking that it’s “just a normal cell”. When it does that, the normal body response of sending T-cells to wipe out invaders is fooled. These T-cells are strong. Very strong. If they get out of control, it can cause horrific damage through a type of reaction called an “auto-immune disease”. The best known of these is rheumatoid arthritis in which the body attacks itself. So T-cells have very tough “leashes” to keep them under control.

A T-cell arrives to attack an internal invader, but the skin of the cancer cell says, “Nobody here but us fat cells! False alarm! Go away! We’re cool!” The cancer has fooled the T-cell and gets off scot-free, continuing to grow out of control.

“Immune checkpoints are molecules in the immune system that either turn up a signal (co-stimulatory molecules) or turn down a signal. Many cancers protect themselves from the immune system by inhibiting the T cell signal.”

What’s that mean? Just that these “immune checkpoint molecules” are signals that tell the rest of the T-cells what to do and where to do it. Cancer blocks or muffles the signal so that the body doesn’t respond as strongly as it should, so the cancer keeps growing.

So what City of Hope is saying is that one of the future therapies may be to

“blockade [the] immune checkpoints” of cancer cells. Your body has many ways to stop the T-cells from getting out of control – checkpoints. You might imagine them as similar to the old “Checkpoint Charlie”, the famous gate from the Cold War through which people from East Berlin and West Berlin could pass from one city to another.

“Immune checkpoints refer to a plethora of inhibitory pathways hardwired into the immune system that are crucial for maintaining self-tolerance and modulating the duration and amplitude of physiological immune responses in peripheral tissues in order to minimize collateral tissue damage.” In plain English? These checkpoints keep your body from attacking itself as well as make NECESSARY immune responses strong and clearly aimed at the invading cells.

“It is now clear that tumours co-opt certain immune-checkpoint pathways as a major mechanism of immune resistance”, in other words, cancer cells take over those checkpoints and tell the T-cells that they’re OK. The body stops attacking and the tumor grows out of control until it’s removed surgically, with radiation, or with chemicals.

So, there’s LOTS of research going on now to create a treatment that will boost the signal from the T-cell that encounters a cancer cell in order to tell the rest of the body that an invasion has begun. The treatment IS NOT READY, but the research is promising!

Resources: http://www.cityofhope.org/blog/breast-cancer-dramatic-advances-create-revolution-in-treatment, http://www.ncbi.nlm.nih.gov/pubmed/22437870

Image: https://image.shutterstock.com/image-photo/closeup-word-encore-painted-on-450w-1143919607.jpg

GUY’S GOTTA TALK ABOUT…Alzheimer’s #22: …and Reconciliation

Dad’s diagnosis of Alzheimer’s stayed hidden from everyone until I took over the medical administration of my parents in 2015. Once I found out, there was a deafening silence from most of the people I know even though virtually all of them would add, “My _____ had Alzheimer’s…” But there was little help, little beyond people sadly shaking heads. Or horror stories. Lots of those. Even the ones who knew about the disease seemed to have received a gag order from some Central Alzheimer’s Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this part of my blog…

I’m a sucker for a movie or book that’s all about reconciliation – The Jane Austen movies are about reconciliation of broken relationships (They’re romances, too, but that’s beside the point). STAR TREK: Wrath of Khan is about reconciliation between Kirk and his son David. Even the Lego Movie has a father-son reconciliation at the end.

The first movie mom and dad brought us to see was the original MARY POPPINS. We saw it at the Terrace Theater in Robbinsdale, the city Mom grew up in. At the very end, Mr. Banks reconciles with his kids, dumping the “bank life” for flying a kite with Jane and Michael.

I’ve been reflecting lately about WHY reconciliation movies and books are so important to me. I’ll be the first to admit that I’m a sort of odd duck in the family. Dad played football and basketball (in the day when players who were 6’1” were tall, he was STILL short!). My brothers and sister played sports all through high school and beyond. Even mom was a member of the Robbinsdale Girl’s Athletic Club – tennis, badminton, and even fencing.

I didn’t do sports. I read. I wrote. I played guitar. I went to a very religious college and then went touring in Minnesota, North and South Dakota, Iowa, Wisconsin and eventually West Africa with two different church bands. I went to Moorhead State University and worked most of my summers at Bible camps.

I wasn’t home a lot because, frankly, I didn’t feel like I belonged.

Then I got older and wiser, got married, then Josh and Mary were born, and then Alzheimer’s touched our lives. After Mom passed, it just seemed to get worse, but I started to spend more time with Dad. Oddly, I started to feel closer to him as we did more and more things together – like watching NASCAR racing, going to restaurants after doctor or dentist visits, or going to The Lookout just because. Our lives began to wind together like they never had when I was younger. We would talk, sometimes just sit together, or go to an event here at SilverCreek and enjoy ourselves. In the end, I felt reconciled – I felt like Dad was part of my life again and that I was part of his. Maybe that’s why the movies like Sing, and Back To The Future – and even FINDING NEMO meant so much to me. They were always about reconciliation; about joining BACK together after a time of separation. And I cried at those movies when I first saw them; and a few days ago, I cried when I realized that me and Dad had reconciled…

Image:  http://az616578.vo.msecnd.net/files/2016/06/25/6360242025150255191939281878_Alzheimer-disease-patients.jpg

The Passing of My Father

The man above is the one about whom I have been writing.

My dad went Home today to join Mom and spend time with friends and family who went before him – his sister, my Auntie June and her husband, Uncle Earl; his parents Ruth and Guy; his Air Force buddy, Roger; and all the other people he’s been missing so much as he fought as far as he could against Alzheimer’s. He is missed; but he is at rest and without pain.