Staying Ahead of the Curve

I’m ½ way through cycle 3, and am just waking up from the weekend; I think I spent Sat & Sun on the couch.  The days begin with high hopes of being productive, but evolves very quickly in to down time. 

While I like to be productive, I need to acknowledge the benefits of down time.  Sleep is good; if you are sleepy, your body is telling you it needs rest.  But rest and sleep doesn’t mean giving in to complacency.  Fatigue is just one side effect, and there is work to be done in keeping up with managing all the side effects.  Here’s a (partial) list from my medical records and what I’m doing about each one.

1.     “Nausea.  Day 1-3 after chemo: Take Compazine twice daily, may take more (every 6 hours) as needed.  Days 4+ from chemo: If still nauseous, alternate Zofran/Compazine every four hours.”  If I wait until the nausea kicks in, it’s too late to address the situation.  This is counter-intuitive to me, as I’m accustomed to physical injuries.  So, I usually stay on this plan up to 7 days after chemo, just to be sure I don’t get nauseous.  I use a pill box to make sure I’m taking the right nausea med depending on what day it is.  The downside is the side effect of constipation, but that’s balanced with #4 below.

2.      “Hypomagnesia - Secondary to Erbitux and diarrhea. Continue oral magneisum with MagOx and give IV replacement PRN.”  This is low magnesium (Mg+).  I’m taking 1200mg (400mg 3x/day) a day, and working on incorporating magnesium rich foods in to my diet – bananas, spinach, edamame, and potatoes.

3.      “Hypokalemia - improved. Continue hi-potassium diet. Will also give IV potassium replacement in ITA PRN.”  This is low potassium (K+).  Low K+ and low Mg+ can be dangerous to the electrical functions of the heart.  I’ve gotten my K+ numbers high enough to stop the supplements, so the focus is on diet.  Potatoes, bananas, spinach, avocado, swiss chard, and more.

4.      “Diarrhea, grade 2 - Stable. Managing with Imodium and Lomotil. Refill provided.”  This is concerning because diarrhea causes dehydration and I lose a lot of electrolytes (including Mg+ and K+).  Alternating the Imodium and Lomotil seems to stabilize the situation.  To be honest, this is one of the reasons I don’t like to go out … you never know when it’s going to hit you!

5.      “Rash - Encouraged rich emollient cream and sun protection. Continue clindamycin gel for face and triamcinolone cream for itchy rash on chest.”  I’m really sensitive to the sun, so I try to stay indoors during the day.  I’m looking forward to the cooler weather so I can get outside more often.  And while the instructions are quite clear on what to do, I haven’t gotten the clindamycin prescription filled because there was a problem with the way it was written.  I’ve gone back and forth with the doctor and pharmacist, and both have me confused.  Regardless, I’m using the triamcinolone cream, and that seems to help keep things in check.  The interesting thing is that I’m generally itchy; I feel it in my mouth and on my body.  For my mouth, I gargle with children’s Benadryl and Sarna lotion is also very helpful for itchy skin.

6.     “Dyspepsia - Give IV famotidine with hydration as needed. Encouraged low-acid, low-residue diet and Pepcid 20 mg PO BID PRN. Consider adding PPI if symptoms are not well controlled.”  This is indigestion.  It took me a while to figure out that there are different reasons for my vomiting.  When I’m nauseous, I’m usually lying down and dwelling on how uncomfortable I’m feeling before I get up to projectile vomit.  In the situation of indigestion, I’m usually a week out from my treatment, and in the middle of something when all of the sudden I’m spit vomiting.  Sigh.  Regardless, the Pepcid seems to be doing the trick to calm things down. 

7.     Weight loss - Discussed high-calorie, high-protein food options. Continue to monitor.  Right now, it’s better for me to just eat, vs. worry about the nutritional value of the foods I’m eating.  My thoughts are on carbs-proteins-fats and adding in what I can to boost Mg+ and K+.

What’s not mentioned above are the mouth sores (which are under control) and recto-vaginal fistula.  For the second one, I just don’t want to go in to the details here, but am fine talking about it in person.

I’ve often heard Cancer patients talk about the “new normal”.  I’m not at that place yet, as the journey is ever evolving – one day at a time, one week at a time, and just general gratitude for everything that I have (even the side effects).