Side Effects Circus!

My last update was almost a week ago, on a Sunday. That Monday, I was still feeling pretty bad, so I stayed home, but I did manage to work most of the day. Part of my job is to maintain and update all the webpage subject guides that I am responsible for, and there is always something that needs to be done to them, so I spent most of the day working on them. You can peruse them here if you are interested.

So I've heard some people describe this blog as "gutsy" and "honest." I guess that's a good thing? I'm going to warn you now that I'm going to honestly and openly describe some very icky stuff in this post having to do with side effects. I decided to talk about these issues (even though some are very private) not necessarily because I want everyone I know to know about them, but because maybe someone whom I don't know is reading this blog and is going through the same things I am and will not feel so alone. Or perhaps someone getting ready to start chemo will be more prepared for what might happen. If you don't want to know about these issues, you may want to skip the rest of this post.

I went back to work on Tuesday, still feeling very fatigued and just kind of not well. At least by this point, the extreme body aches/soreness had abated. At its worst, this side effect felt like someone had beaten me about the body with a baseball bat, more than just muscle soreness, sort of a very bruised feeling, mostly throughout my torso and up into my neck. When I went in for my weekly lab work this past Thursday (my counts were very good, btw), I asked the Good Nurse Sue about this problem since it was new for me. She said it is not an uncommon side effect of chemo; she also said it could have been that my white counts dipped really low very early and the Neulasta kicked in at that point (this drug has the common side effect of causing bone aches when it starts working because it stimulates one's bone marrow to produce white blood cells). Since the soreness was centered so heavily between my ribs and hips, I was concerned that I might be experiencing liver problems (obviously, one's liver is heavily stressed by chemo), and I asked Sue about that. She responded that they do not test for liver function during the normal weekly lab work (which is just a simple CBC), but they do perform a complete panel that looks at liver function with the lab work that is done just before one gets a chemo treatment. So if there were any problems with my liver, they would have shown up Thursday a week ago before I got my chemo. And they didn't. Whew.

At the point that I started to feel systemically human again, which was around Monday or Tuesday, I started to get other side effects that were local. Sadly, the bleeding and extreme pain during bowel movements came back. Also, the skin in my private parts (front to back) became very inflamed and painful and was sort of oozing/weeping a small amount of blood pretty much all the time. This started on Monday and was very bad for the next two days. It had started to get very slightly better by Thursday, but I made sure to tell Sue about it when I was in for my lab work. She immediately told me to drop drawers so she could have a look (an aside: you know you're not exaggerating your own systems when an experienced oncology nurse has a sharp intake of breath upon seeing a problem, which was the Good Nurse Sue's reaction). She said it looked like a fungal infection and told me she would give me a prescription for a cream that would help. She also prescribed a suppository containing steroids for the internal problem(s). The external cream gave me almost immediate relief; the redness is still there, but the bleeding has stopped, and it's not nearly as painful. The internal problem is a bit better, but not much. I'm hoping that it's just an issue with this type of medication taking longer to help. From what I've gathered on the Internet, this type of fungal infection is not uncommon in people with compromised immune systems:

The most common organism implicated in fungal infections is the ubiquitous Candida, which is found in the human digestive tract, mouth, and genital region (Eggiman P et al 2003). Under normal circumstances, levels of Candida are controlled by beneficial bacteria. However, if the bacteria-fungus balance is upset, by the use of antibiotics for example, or if the immune system is compromised, an overgrowth of Candida can occur, resulting in infection (Braunwald DE 2001).

The other problem I've been having is a very painful feeling that food is getting caught at a point in my esophagus that's in the middle of my chest area. It's especially bad when I eat anything dense, such as bread or red meat. This is actually a problem that I've had for years, but it's been really exacerbated since I've been on chemo. I told Sue about this issue as well, and she gave me a prescription for a heartburn/antacid medication. I've been taking it since Thursday, and it's really helped.

So those who talk about very unpleasant chemotherapy side effects from mouth to anus are not in the least exaggerating, I can now attest. I got some more information here:

Mucositis (also known as stomatitis) is the swelling, irritation, and ulceration of the cells that line the digestive tract. These cells reproduce rapidly and have a shorter life span than other cells in the body. Because chemotherapy agents do not differentiate between healthy cells and cancer cells, they can quickly destroy digestive tract cells, breaking down the protective lining and leaving them inflamed, irritated, and swollen. Mucositis can occur anywhere along the digestive tract from the mouth to the anus, and can be aggravated by nausea and vomiting.

I hope this information hasn't been too disturbing for you to read. It's difficult for many people to talk about and deal with honestly, so that's all I'm trying to do.

Other than dealing with all these side effects, it's been a pretty good week. I enjoyed being back at work and feeling productive. Sadly, one of my colleagues has been out sick all week and will be out next week as well (Get Well, Anne!), so I've been doing a lot of extra shifts on the reference desk, and enjoying them all. We are very, very busy right now; so many students have research papers due now before the big bang that is final exams. I haven't felt like being on Warcraft at all, which I am missing, but maybe this evening I will get a some time to play and actually feel well enough to be on (I find that when I'm even slightly nauseated, the game can make that feeling much worse; it must have to do with its immersiveness and the motion on the screen).

I hope you are well, loved, warm, and happy. Peace, Jody