The "C" word. Are we talking about cancer or chemo? Doesn't really matter, because they're both horrendous. But in this case, I'm talking about chemo and all of the wonderful side effects that come with it. Since there are so many types of chemotherapy and each type offers unique side effects, I will be specifically commenting on my personal experience with Adriamycin/Cytoxan (AC), and Paclitaxel (Taxol). While I don't want to scare you if you haven't started treatment yet, I want to be completely honest so you know what to expect, as well as offer some tricks to help get you through.
Lets start with AC aka the red devil. It has this nickname for a reason. This chemo was quite possibly my least favorite part of my cancer journey, and that's saying something. Here are some of its not so fun side effects:
Nausea - AC is known for inducing awful nausea. When I heard that, I was not pumped. But, the good news is there are so many medications around now to help combat this! Every time I received chemo, I would get loaded up with meds beforehand to help prevent nausea. Some of these meds included Decadron (a steroid), Aloxi (an anti-emetic, meaning it prevents nausea), and Cinvanti (an anti-emetic designed specifically to be given with chemo). When those meds didn't seem to be enough, my doctor was more than willing to prescribe even more drugs. On top of the meds, it also helped and was recommended to eat small, frequent meals. If your stomach always has a little something in it, you're less likely to become nauseous. After my first round of AC, I did get so nauseated that I vomited, but I told my oncologist right away, and she was able to prescribe me some medications to take at home including Zofran and Compazine (both antiemetics). I found that my doctors would pretty much do everything possible to help decrease side effects which was a huge relief. They even gave me Zyprexa, which all nurses know is an antipsychotic and used to calm down those crazier patients. Who knew it could help with nausea as well!
Heartburn - I thought I'd experienced bad heartburn before, but after receiving AC, I realized I was wrong. My heartburn was bad enough that I always had tums on hand and thankfully they seemed to help to some extent. I also took Prilosec twice a day, to help decrease stomach acid. While you can get these medications as well as many others over the counter, make sure you discuss with your physician before trying a new medication. It also helps to avoid acidic, spicy foods, and to refrain from eating close to bedtime.
Hair loss - The dreaded and probably most well known side effect from chemo. In fact, when most people think of cancer patients, they think of bald people. While everyone deals with hair loss differently, this was way harder for me than I ever expected it to be. Something I did to help cope with my hair falling out was cutting my long hair a little shorter before it fell out, just to ease myself into it. Once it started falling out around day 16, I ended up shaving my head to ease the pain. Not only can it be physically painful if you have long hair that's falling out, but it also helped ease the emotional pain so I didn't have to see such long clumps of hair falling out. Some people choose to invest in cold caps to prevent their hair from falling out; however after looking into it, I decided it wasn't the right choice for me. Not only are cold caps expensive, they also require a lot of time and patience, and I've always been a pretty low maintenance person when it comes to my hair, so I decided it wasn't worth the hassle to me. If it is important enough to you to keep your hair, then cold caps might be a great option for you! One plus to my hair falling out was that it fell out of my legs and armpits, meaning I didn't have to shave. Can't complain about that one!
Fatigue - Okay, let's talk fatigue. The fatigue I experienced with AC was so extreme, it's hard to put into words, so I will do my best. Once the IV infusion was completed and I got to the car, it took everything in me to keep my eyes open. I would definitely recommend having someone drive you to and from chemo for this very reason. After my very first dose, I remember getting home and passing out in my dad's recliner for who knows how long. Imagine feeling like you've been hit by a truck, haven't slept for a week, while having the worst mental fog of your life. That's the best way I can describe this feeling. Extreme physical and mental exhaustion that forces you to use everything you have to be able to walk up a flight of stairs or even keep your eyes open to watch a movie. What helped me get through this? Not a whole lot, so I listened to my body and slept as much as a I could. Naps become your best friend, so take them whenever you need. I also learned over time that my fatigue was the worst for the first 2-3 days after chemo, and then the fog would slowly start to lift. I would definitely recommend having others around to help you with daily chores and meals for those first few days. I do know some boss women who have done everything themselves, but I honestly don't know how they did it!
Constipation (or diarrhea) - AC affects people differently, so some people get diarrhea and others get constipation. After starting AC, I quickly learned what true constipation was. It can be hard to know how you're going to react to the red devil, but the one thing that will help with both diarrhea and constipation is to stay hydrated. Drink as many fluids as possible, and it will not only help with your bowels, but also with energy levels. If you start feeling any bit of constipation, take a stool softener such as Colace on a daily basis. I also ended up having to take Miralax to help me have a bowel movement. Stay away from suppositories as they can irritate your rectal tissues (gross, sorry) and cause infection.
Mouth sores - I had a couple mouth sores, but nothing too crazy. Staying away from acidic foods helped, as well as doing daily mouth swishes with warm water and salt!
Low blood counts - When I say low blood counts, I'm specifically talking about low white blood cells (WBC). WBC's are what help your body fight infection, so when they become low from chemo your doctor may tell you you're immunocompromised. Unfortunately there isn't much you can do about this yourself, other than doing your best to stay healthy. With certain types of chemo there are medications you can take to help stimulate your bone marrow and increase your WBC counts, but this isn't always the case. Chemo can also reduce your red blood cells. For someone like me who is chronically anemic, I actually had more problems with my hemoglobin dropping during AC than my WBC. Because of this, I required a few blood transfusions during this time. If you start feeling short of breath, dizzy, or more fatigued with daily activities such as walking, or if you become pale, these can all be signs of low hemoglobin. Your doctor will be monitoring your labs very closely during chemo, but it doesn't hurt to know what symptoms to be looking for.
Chemo brain - I remember the first time I heard about chemo brain, thinking it sounded like an excuse for having a bad memory but it's totally a real thing! Along with the fog I described above, you can also have a harder time concentrating and remembering things. I definitely experienced this for the first few days after I got an infusion of chemo. I remember sitting in the chemo chair not being able to concentrate enough to read or watch tv which is abnormal for me. While there isn't much to do to make this better, I found that sleeping it off helped! I also found coloring books to be a helpful way to pass the time since it's a pretty mindless activity.
Next, we have Taxol. Compared to AC, this chemo is a breeze! While it definitely still has side effects, I lucked out and barely experienced any of them, so I will comment on what I know first hand, as well as some of the known side effects I was fortunate enough to not experience.
Hair loss - Since I received AC before Taxol, the hair on my head had already fallen out, but I knew that Taxol often causes even more hair loss including eyebrows and eyelashes. In order to be prepared, I went to Sephora when I still had my eyebrows and eyelashes, so I could get some assistance with finding a long lasting eyebrow pencil that matched my hair color. I also purchased multiple pairs of false eyelashes and ended up becoming a pro at applying them for special events. Some women, choose to wear fake eyelashes on a daily basis, and I've heard that the magnetic strips can be easier to apply that the classic eyelash glue.
Nausea - while the chances of becoming nauseous are much lower with Taxol than AC, some people still experience it. I was fortunate to not experience nausea or any GI symptoms with Taxol, but if you do find you're nauseated, look at my recommendations above for nausea.
Neuropathy - This is one of the most common side effects from Taxol. Neuropathy is numbness, tingling, pain, or sensitivity to hot/cold most often in the hands, feet, arms, and legs. I was so lucky and did not experience any neuropathy at all, although I'm definitely the outlier, and my oncologist was not surprised by this as the two biggest risk factors for neuropathy are age, and diabetes. There are medications that can be prescribed for neuropathy symptoms, so if you experience neuropathy just make sure to voice your concerns to your oncologist.
Low blood counts - Just like AC, Taxol also causes low WBC, also known as neutropenia. Because of this, my oncologist prescribed a drug called Neulasta. This medication helps your body make WBC's by stimulating your bone marrow. The purpose of this is to be able to fight infection more effectively. One weird thing about this medication is the way it is administered. The nurses will poke a small needle into the back of your arm or stomach that's attached to a pod containing the medication. The pod will later inject the medication on it's own after about 24-36 hours from your chemo infusion. Some people do experience bone pain, especially in their joints, from this medication. I had mild bone pain, and found that taking Claritin, as well as Tylenol and Ibuprofen can help with this.
While I'm sure there are side effects I didn't cover, I hope this information is helpful for those who are just starting AC and Taxol. I know firsthand that starting chemo is very intimidating and overwhelming, so it's my prayer that even this little bit of knowledge will help someone else's journey become that much easier. Also, don't forget to celebrate once you complete chemo. It is truly an amazing accomplishment.
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