Breast Cancer – The Side-Effects of Tamoxifen

mammogramI have had breast cancer. After the surgery, the chemotherapy and the radiotherapy, I have spent the last 5 years being treated by the drug letrozole to avoid recurrence of the disease. Last month, I had my annual check-up and mammogram and was found to be 5 years cancer free. Result! However, my tumour was HER2+ and therefore my oncologist has advised another 5 years of endocrine teatment with Tamoxifen.

I suffered from almost every side-effect of Letrozole, so it is important to me to be aware of the side effects I may have to endure while taking Tamoxifen. Everybody reacts differently to drugs and some people experience more severe side effects than others, some are really lucky and are not aware of any side effects.

The most common side effects that people have when taking Tamoxifen are much like Tamoxofen packetthe symptoms of the menopause. They include hot flushes, night sweats and sleep disturbance. Other common side effects are vaginal irritation, loss of sex drive and mood changes. Women who have regular periods are likely to find the flow may be lighter, irregular or stop altogether. However, vaginal discharge is common while taking Tamoxifen and so you should be aware of the possibility of infection,.

One of the positive side effects of Tamoxifen for women who are post-menopausal is that this drug is found to slow down the progress of osteoporosis which is thinning of the bones. Conversely, women sho are pre menopausal may be at risk of thinning bones while taking Tamoxifen.

pulmonary embolismThere are other side effects of Tamoxifen that are less common. The drug increase the risk of getting blood clots including deep vein thrombosis (DVT). This can be very serious as people with DVT are at risk of developing a pulomary embolism. Therefore people taking Tamoxifen need to be aware of blood clots and ways of helping to reduce this. Lengthy periods of inactivity can increase the risk of developing bood clots. Those who take long flights, car journeys or train trips need to be aware of the this.

My oncologist also warned me about the fact that Tamoxifen can afftect the lining of the womb and cause it to thicken. In a few cases Tamoxifen can even cause polyps, ovarian cysts or womb cancer. As my family is complete, I have told the doctors that I would look to have a hysterectomy, should that occur.

letrozole-hairA change in hair may also occur. A small number of women may find they notice an increase in downy facial hair and changes to their singing voice. Others find they suffer hair loss or thinning while taking tamoxifen. I suffered hair loss while taking Letrozole, so will be particularly alert for this side effect.

Sight may also change. Make sure to make your regular visits to your optician during treatment.

Tamoxifen can also cause changes to liver function. However, the changes to the liver are usually mild and you may not notice them. At the end f your Tamoxifen treatment your liver will probably return to normal.

Amongst the other side effects are joint pain, tiredness, difficulty concentrating, letrozole-fluidheadaches and leg cramps at nght. Some women also suffer weight increase.

My oncologist has told me that Tamoxifen usually only results in mild side effects. However, I encountered many of the side effects with Letrozole and fear Tamoxifen may be the same. They cause me distress, pain and make me self conscious. However, if Tamoxifen keeps the dreaded breast cancer at bay, I will take the tablets and live.

Valerie Penny

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Radiotherapy after Breast Cancer

My Uncle suffered from colon cancer and had told me that radiotherapy was not nearly as difficult to bear as chemotherapy. However, when I came to receive radiotherapy for my breast cancer, I came to disagree with him. Radiotherapy treatment is planned and delivered by specially trained professionals called therapy radiographers. It is given by a machine called a linear accererator. Breast cancer patients are usually treated for between 3 to 6 weeks.

The treatment only lasts a few seconds, but to get prepared and settled on the machinery, the period each patient is in the room is about 10 minutes. I needed four weeks treatment. It is given on week days, every week day except for public holidays, for the stated period, so I had to go for treatment 5 days a week for four weeks.

The treatment, at least at first, is painless. Still, reasons that I did not agree with my uncle were that the journey to the hospital that delivers the treatment is an hour’s drive from where I live, and an hour’s drive back. Given that and the wait for treatment at the beatsonhospital could mean a 3-4 four round trip. That was terribly tiring. Also, the treat ment is given in a large room that contains nothing but a chair to place my cloths on, a screen for the radiographers to stand behind as they deliver treatment and the machine, itself.

Patients are not treated by the same radiographers each day and students, male or female, may be amongst the team. I should have been asked if I was willing to have a student present , but I never was. Like many who suffer from breast cancer, I come from a generation that is not used to displaying my body to other people, especially much younger men. I was simply told to take off the clothes on my top half and come over to the machine. It was embarrassing and demeaning. I was just given a piece of paper towel to cover my modesty. Needless to say, that did not work!

The way this treatment was delivered was embarrassing and demeaning. The journey to get the treatment was long and tiring. During treatment I had to lie in a specific position so that the radiotherapy could be delivered most accurately. The radiographers dimmed the lights for a short time while they positioned the machine. They then stood behind the b machinescreen while the treatment was delivered.Once or twice the treament given was slightly different in that it was a boost to my scar area. However, the method of delivery and the lack of attention to personal sensitivities was the same as ever.

The treatment results in a cumulative effect to the cancer and side effects. At first, I felt no different after treatment. It was only after two weeks or so that I bagan to feel side effects and so terribly tired, weary, as a result of the treatment. It also caused burning on and in the flesh around my breast. The hospital provded aqueous cream to soothe that.

I needed the radiotherapy to help beat the cancer, but it was difficult to bear.

Valerie Penny

Breast Cancer and Herceptin (Trastuzumab)

During my treatment for breast cancer, I was part of a medical trial in relation to the effecacy of the drug Herceotin (Trastuzumab). Herceptin is a drug that belongs to the group of drug treatments called targetted or biological therapies. It stops specific ways that breat cancer cells divide and grow. I was treated with Herceptin because my cancer cells were found to have a higher than normal level of the protein Human Epidermal growth factor receptor 2 (HER2) on their surfaces. That stimulates the cancer cells to breast-cancer-s10-photo-of-her-2-genegrow. Herceptin works by attaching itself to the HER2 receptors so that the cancer cells no longer grow. it also stimulates the body’s immune system to fight the cancer cells.

I am one of the 20% of breast cancer patients to benefit from Herceptin as my tumours were the fast growing ones that are HER2 positive. I was given the Herceptin along with chemotherapy after my surgery in order to reduce the chance of the tumours spreading or returning. If your breast cancer is not HER2 positive or, indeed, HER2 negative, Herceptin will not be effective to you.

The Herceptin treatment I was given for my breast cancer was given to me intravenously through my Hickman line on the same days as my other chemotherapy. I was treated every three weeks as an out patient. However, the days were long, as the Herceptin was given over 90 minutes with additional time taken to give me saline solutions and my chemotherapy. I had to stay in hospital for several hours in case I was allergic to the treatment. Luckily I was not. However, like all drugs, Herceptin has side effects.

The common side effects of Herceptin include: feeling like you have flu, nausea and diarrhoea. I had all of these. I felt pain in my muscles and joints and often felt breast-cancer-s2-breast-cancer-illustrationlike I had a temperature so I swung between feeling hot and cold. I also had to have treatment with anit-sickness drugs for the servere nausea I suffered. I also got medecine from the hospital to counter the diarrhoea that I suffered.

The trial I was part of was looking into reducing the period of time that women are treated with herceptin, to see if it makes a difference to the efficacy. The usual period for getting Herceptin is about a year. I was treated with it for 9 weeks. I found the hospital visits and the side effects very draining, so, although I had initially felt diappointed that I was only receiving the treatment for a shorter period, in the end I was quite glad to get to the end of the course of Herceptin.

Valerie Penny

 

 

The Longest Day of Chemotherapy

It was Tuesday, 5th June, Jubilee Day. Most of the UK was celebrating the 60 years of the reign of Queen Elizabeth II with an extra public holiday.   I marked the day with my first day of chemotherapy.   It was certainly memorable!

I met with the oncologist at 9.30 am.   She told me my blood results and scans from the previous week were satisfactory as a result of this,  I could go ahead with chemotherapy today as planned. This was both a relief and a challenge.  A relief because, due to my depression, I am not good at dealing with changes in plan.  A challenge, of course, because this meant, again,  it was made real to me that I had breast cancer a condition that required lengthy and invasive treatment.  Reality struck again.

Fortunately my husband was with me.  His very presence keeps me calm.  It was during this appointment that my breast cancer nurse, Angela Wallace, began to explain some of the side effects of the chemotherapy that I might expect. These were difficult to hear. The cancer had been caught so early that I had not recognised any symptoms of the disease in myself.  I felt quite resentful to hear of the side effects I might suffer from the cure.

She explained to me that I would be entitled to a wig, in case I suffered from hair loss.  She also told me that the hair loss would be likely to be from all over my body and that I could expect, among other things, to suffer from a dripping nose. It all sounded distressing and disgusting.

I told Angela that I did not think I would bother with a wig.  I thought it would be too hot during the summer. However, she explained to me that it can sometimes be easier for other people if I wear a wig, especially my mother and my children.   She also drew to my attention that my treatment would last well into October and therefore it would be the end of the year, a much colder time of year, before my hair would begin to grow back.  This was another reality check.

Chemotherapy is a treatment which uses anti-cancer drugs to destroy cancer cells. The drugs work by attacking the cancer cells and disrupting their growth. Unfortunately, they can also affect the normal cells in the body, including the cells of the hair follicles. This causes hair loss, also known as alopecia. Unlike cancer cells, however, the normal cells quickly recover, so if you lose your hair due to chemotherapy it will almost always grow back when your treatment is over.  Before you start chemotherapy, your doctor or chemotherapy nurse will discuss the possibility of hair loss and other side effects with you.

Not all chemotherapy drugs make your hair fall out, and sometimes the loss is so small it is hardly noticeable. However, some people will have temporary, partial or complete baldness.  Some chemotherapy drugs make other body hair fall out, such as eyebrows, eyelashes, nasal hair, beard, moustache, chest, underarm, leg and pubic hair. The amount of hair that falls out depends on the drug or combination of drugs used, the doses given and the way that your body reacts to the drug.

If your hair is going to fall out, it usually starts within two to three weeks of starting chemotherapy, although very occasionally it can start within a few days. The first thing you may notice is that your hair starts to come out more when you brush, comb or wash it. You may also find hair on your pillow in the morning.

Hair may just thin and become dry, fragile and break easily. For other people their hair may carry on falling out over a few weeks so that they become completely bald. Sometimes the hair comes out very quickly over 1-2 days, which can be very upsetting. Some people find that their scalp feels tender.

It was all so much to take in.

Angela explained to me about a method of trying to prevent or reduce hair loss. By cooling the scalp.  It is sometimes possible to reduce the amount of chemotherapy drugs that reach the hair follicles on your scalp. This reduces, and in some cases prevents, the hair from falling out. It is done by using a ‘cold cap’ or a machine that cools the scalp.  I decided to try that.  I was to go to the ward for my chemotherapy by 11am, so my husband and I had time for coffee in the hospital canteen before we went up, but life is never that simple! It is Jubilee Day. The canteen was closed for the public holiday – so we settled for coffee from a machine. Yugh!

  When we went to the ward, I was reminded of all my friend, Margaret Boe, had told me. She had been given the all clear after her breast cancer last October. She said that the ward was a surprisingly happy place. She told me every body, staff and patients alike were very friendly. She said everybody was happy there, but her husband, Billy, said he had not been happy and he found the whole experience of being present at Margaret’s treatment terribly difficult no matter how pleasant the surroundings were. In any event, I was glad to have my husband’s company and support. While this was a long day for me, at least I was the centre of attention. It was an even longer day for him. I was nervous and anxious. It was so important to me to have him there.

I was shown into the treatment room. There were 12 treatment chairs and I was shown to one that accommodated the use of a cool cap too. In the corner of the room a TV high up on the wall ran the Jubilee Day celebrations all day. In our neck of the woods the weather was beautiful but we watched the Royal Family enduring the downpour in London, England for  hours as they stood waving to the crowd. While I sat on the chair waiting for my treatment to start I was anxious. I was pleased to be starting my treatment, anxious about what it held for me and even more pleased that I was not in London getting drenched watching the Flotilla on the River Thames.   

The first struggle for the nursing staff was to get a cannula fitted into a vein in my left hand. That proved to be more of a struggle than expected so the staff began talking about getting a Hickman Line inserted into my chest.  This was to make taking blood and inserting chemotherapy easier in the future.  I was put more at ease when a woman came round and offered us all a cup of tea or coffee and a biscuit. Even the visitors got offered one. My husband was pleased!

In the meantime my treatment today began with a saline solution being inserted into my vein before two different antihistamines were added to the cocktail.  Antihistamines are a type of medicine often used to treat a number of allergic health conditions. Antihistamines work by blocking the effects of a protein called histamine.

Histamine is a protein that the immune system uses to help protect the body’s cells against infection. The immune system is the body’s natural defence against illness and infection.  If the immune system detects a harmful foreign object, such as bacteria or a virus, it will release histamine into nearby cells. The histamine causes small blood vessels to expand and the surrounding skin to swell. This is known as inflammation.  

The expansion of the blood vessels allows an increased number of infection-fighting white blood cells to be sent to the site of the infection. The swelling of the surrounding skin also makes it harder for an infection to spread to other parts of the body.

Histamine is usually a useful protein, but if you’re having an allergic reaction it’s sometimes necessary to block its effects. Allergic reactions occur when your immune system mistakes a harmless substance, such as pollen, as a threat.  The release of histamine causes the process of inflammation to begin and leads to nearby tissue becoming red and swollen. It can also affect the nerves in the skin, making the skin feel itchy.

I had been in the cancer treatment ward for over 2 hours and the chemotherapy itself had not started.  The next excitement was that the woman who had come round with the tea earlier came back. This time with bowls of soup and a choice of sandwiches for all the patients and the visitors. By this point she was my favourite member of staff!

Another nurse set me up for more saline drip: another half hour passed. It was only then the chemotherapy began and I got hooked up for my course of herceptin. The time lapse was this was to be another hour and a half. My husband took an opportunity to go for a walk and buy a magazine and a paper at the hospital shop. This opened in the afternoon notwithstanding the public holiday. He needed to stretch his legs and move around a bit. I really didn’t blame him for that.  By now it was almost 2pm and we had left the house more than 5 hours previously, it was clear it was going to be a long day: a very long day.

While the herceptin dripped into my vein I sat and flicked through another magazine left by someone in the ward. Herceptin is a cancer medication.   It interferes with the growth of cancer cells and slows their growth and spread in your body.  Herceptin is used to treat breast cancer that has progressed after treatment with other chemotherapy.

I was glad when my husband got back. I know the day was boring for him, but I was happy to have his company and support. I am not sure I ever told him that. I just expected him to know. When he did come back I did the puzzles in the magazine. It was something new to look at and think about apart from the unceasing coverage of the Queen and the Duke of Edinburgh endlessly waving to the crowds in the rain.  

The afternoon rumbled on and my favourite staff member came round again, this time with another cup of tea or coffee for the patients and family members with them. This woman secured her place in my heart!

After the dose of herceptin had completed, I was given another dose of saline and then the cool cap was switched on so that it would be ready for me to wear by the time I was ready for my dose of docetaxyl. Time continued to pass.  My favourite nurse was the person who put the cool cap on for me. It had to go on a full half hour before I started taking the docetaxyl at 4.50pm.

My husband was getting bored again. Who can blame him for that? He left the ward to go down to the car park. It was emptying fast as staff came to the end of their day and clinics ended, yet evening visiting had not yet started in the wards. He took the chance to move our car closer to the hospital so that I would not have so far to walk when we, eventually were able to make our way home. That time still seemed so far away to me.

Almost all the chairs in the ward had been used during the day. Now there was only one other patient, no great surprise really, most of the staff in the ward finished their shift at 5pm. This really was a marathon session.

The other patient in the room was a woman who was further into her treatment than me. Her daughter and two grandchildren were with her. The grand daughter was asking about the cool cap I was wearing. It did look a bit like a cycle cap and felt a bit like it does when you are standing in New York City, New York, USA in January waiting for a taxi. The only difference is there is no wind in the cool cap!

It was quite re-assuring to notice how accepting the family were of the woman’s hair loss and treatment. I am not looking forward to the prospect of losing my hair. My hair has been thin for some years due to an under-active thyroid, but the thought of losing it all together makes me very self-conscious.

So another hour passed while I sat with the docetaxyl dripping into me. By 6pm even the woman with the grandchildren had left and my husband and I were alone in the ward waiting for a nurse to come and unhook my drip. Even then the day was not over. When, eventually, the last nurse on duty in the ward came back in she told us the cool cap needed to stay on for another 20 minutes.  The nurse’s shift ended and she left. My husband and I were alone in the ward. He had been given instructions by the nurse as to how to turn off the cool cap and remove it from my head. It felt strange to be leaving from a completely empty ward.

My goodness I was tired by the end of all that. Not just because it had been such a long day, but also because everything was new and strange and stressful. The shops were shut when we were driving home by the time we got there we had been away from the house for over 11 hours. It was as long a day and as stressful day as I could remember. We were both too tired to cook, so we decided to pick up a meal from our local Chinese takeaway restaurant. This was a welcome end to the longest day.

Valerie Penny

A Pleasant Interlude Before Chemotherapy for Breast Cancer

There is a time of year, it is usually around the second half of May when school children and students are studying for exams. They spend hours and days inside and in the libraries, so what happens? The sun comes out!  

This year was no different. During that sunny weather at the end of May, before the chemotherapy for my breast cancer began. My husband and I arranged for my mother to visit with us for a few days holiday, before I suffered hairloss and other side effects of the treatment. A mother should not have to witness that, if it can be avoided. During that week I did have to meet with my psychologist for my usual two-weekly therapy session.

I was able to air my feeling of resentment that I have never smoked, do not drink excessively and do take exercise. Nevertheless, cancer was the card I had drawn.  One day was interrupted when I had to go back to the hospital, this time for an initial set of blood readings to be taken before my chemotherapy sessions start. The hospital even did a pregnancy test! As if my long suffering husband did not have enough to worry about! I also had to go to the hospital for a cancer clinic visit with the oncologist and collect medications that I would need to take before chemotherapy began at the beginning of June.

We went to lunch with Mum and she had time to visit her friend who lives in the South of the county. Sometimes it was warm enough, just to sit in the sunshine in the garden and relax.

I was glad my mother was able to visit before the chemotherapy started and to see me still looking and acting like me. I had felt able to do plenty of home cooking and baking so we were able to ensure that many of her favourite recipes were served during her stay.  My mother had been treated for bowel cancer about four years ago and is presently cancer free.

She dealt with her ailments with dignity and an uncomplaining grace, even when the hospital infected her wound with MRSA. MRSA stands for methicillin-resistant Staphylococcus aureus.  Staphylococcus aureus is a species of bacterium commonly found on the skin and/or in the noses of healthy people. Although it is usually harmless at these sites, it may occasionally get into the body (eg through breaks in the skin such as abrasions, cuts, wounds, surgical incisions or indwelling catheters) and cause infections.

Patients may be colonised with MRSA when they leave hospital, and there has long been concern that MRSA might spread from hospitals into the community.  It was certainly true with my mother. Her condition was complicated by the fact she is allergic to penicillin.

I try to emulate her dignity and calm, but fall far short of the mark, I fear.  During my Mother’s visit the wkwriters had a visit from Gerry McGrath who read some of his poetry to us and focused on Blank Verse. One of Gerry’s anthologies of poetry is reviewed at https://bookreviewstoday.wordpress.com/2013/04/05/from-a-to-b-by-gerry-mcgrath/ My mother was able to join us for that meeting. I also re-read Made in America by Bill Bryson which I have reviewed at https://bookreviewstoday.wordpress.com/2013/04/05/made-in-america-by-bill-bryson/. The visit was a pleasant interlude and allowed me to divert my thoughts from cancer.

Valerie Penny

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