Management of side effects of chemo therapy

After going through the information about cancers in general and lymphoma in particular, available on the Internet, I have come to conclusion that most of the cancers are completely curable if one can handle the side effects of therapy. I think patients should collect full information about the cancer, prescribed drugs, action of the drugs and their side effects and knowledge about management of side effects so that one fully understands what exactly is happening. I have noted that many people are scared even to pronounce the word cancer. New drugs are being introduced as a result of painstaking researches, experience and knowledge of doctors is improving fast and therefore a patient should also change the old perceptions and get ready to manage the side effects. I have been trying following supplementary therapies to my benefits.

Pranayam: I practice “Pranayam’ at least for one hour every day. Pranayam is breathing exercise that improves efficiency of our respiratory system which results in to supplying more oxygen and nitrogen to the blood that acts as nutrients to the cells. The easiest method of this exercise is to inhale through one nostril (closing the other) slowly, as deep as possible and then exhaling through the other slowly. Deeply inhale through left – fully exhale through right – deeply inhale through right and fully exhale through left makes one cycle. You may sit in comfortable position; I prefer to walk slowly in the room with fresh air to avoid boredom of sitting in one place for long time. I also split this in to two sessions of 30 minutes each in the morning and evening. Depending on the availability of time I extend these sessions to one hour also at times.

During one of such sessions, a thought flashed my mind that since the breathing exercise provides more cellular nutrition, whether I am making my cancerous cells also strong? When I pondered over this possibility for some time I thought that yes, let it be so, there are few cancerous cells that are outnumbered by good cells and therefore making both types of cells strong will be analogues to a fight between strong fellows, which is more damaging than fight between week fellows and here I need more and permanent damage to my cancerous cells. I feel very energetic and fresh throughout the day.

Mind control or programming the brain: I had undergone a basic course on Silva Mind Control few years back and since then I started to appreciate power of brain that can be positively used. Here I get an opportunity to use the technique on my body so that I can evaluate the results myself and that could be a useful experience for me as well.

After taking bath I lie down on my bed, cover the eyes with a black cloth to prevent disturbing light, take 2-3 deep breaths and count 100 to 0 which helps me relax my body. I scan my entire body to check whether all muscles are relaxed and I am comfortable. I imagine myself lying in a very pleasant environment mostly in a green cool place surrounded by hills. I visualise that my body is cooperating with the therapy and drugs are doing their desired job. I also visualise that old cells are fast replaced with new and fresh ones thus I am becoming more energetic and healthy. I do this session for about 30 minutes and feel very good, perhaps this may be one of the reasons that I did not have much of problems by side effects of chemo therapy.

Music therapy: Immediately after the mind control exercise, I listen to music that includes western classical and Hindustani. With whole body relaxed, I try to listen intensely and note every beat. I try to imagine a picture suitable to the form of music for example, while listening to some of the symphonies of Mozart a scene of ballet automatically appears or while listening to Pandit Hariprasad Chaurasiya, I remember a great mehephil which went on till 4 am in the Nagpur University hall in Nagpur that I attended about 30 years ago. I prefer flute to other instruments because that gives me a feeling of peace. This therapy goes on for about one hour.

Observations after the First Cycle of Chemo

Side effects of chemo therapy: I started getting headache next day at about 9 AM and was discharged at about 11.30. Doctor advised me to take Crocin but since my experience with crocin is not good (stomach upset), I avoided. I was feeling intoxicated equivalent to having had a bottle of beer, though the headache was not allowing me to enjoy that beer effect, I tried to sleep with my eyes completely protected from light for about two – three hours and then the headache subsided.

Nausea: I felt light nausea for only about 6-8 hours I could take my food in small quantities and was taking sufficient liquid. Avoided taking milk next day and thereafter regularly taking curd and buttermilk twice a day

Headache and fever: For about 3-4 days I had light headache and was feeling feverish after which I took one Combiflam and thereafter I had complete freedom from these problems. As an extra precaution, I avoided bright light, which is one of the sources for my headache.

Constipation: Though normally I don’t have constipation, for two days after chemo, I had it, I started taking 3 tsp of Isabgol (psyllium husk) with milk in the evening daily so this problem was also overcome.

Insomnia: I could sleep well only the first night due to that beer effect but second night was terrible. I was feeling very fresh and in spite of all my attempts to fall asleep including reverse counting etc, I couldn’t succeed so next night onwards started taking Restyl (0.5mg). It gives me a sound sleep of about 6 hours. I tried to skip once or twice but couldn’t sleep so I think I will have to continue taking one tablet every night.

Body ache: For 2-3 days I was feeling weak leg muscles had severe pain in both the wrists, about 6-7 cms from bottom of the palm, almost in the centre. Acupressure technique did not work. I had observed such pain in the past caused due to loss of electrolyte. (such pain was observed in past usually as an after-effect of taking more than 2 drinks and my remedy to it was a glass of lemon water with more salt) Taking lemon+salt+sugar did not help so I took Electral for two days and the problem disappeared.

First Experience of RCV-P treatment

Tata Memorial Hospital Mumbai (http://tmh.gov.in) has a very systematic approach for confirmation of diagnosis and planning drugs for the therapy through their Lymphoma Clinics. A committee of doctors examines all reports, discusses the pros and cons in the presence of a patient, and informs the patient about selected course of action. I was personally impressed by this open approach. In my case, treatment of R-CVP chemo therapy was decided on 15th December and first cycle of chemo was completed on 16th December.

RCV-P means

R – Rituximab (monoclonal antibody). This antibody attaches itself to CD20 protein of B cells that are cancerous. The immune system then picks out such B cells and destroys them, healthy B cells do not carry CD20 and therefore remain unaffected,

C – Cyclophosphamide (chemo therapy)

V – Vincristine (chemotherapy)

P – Prednisolone (Steroid)

Details of functions and its side effects can be viewed at http://www.cancerhelp.org.uk/about-cancer/treatment/cancer-drugs/r-cvp

Observations during the RCV-P administration: Rituximab was administered @ 15ml/hr in the beginning for about one hour, followed by 25 ml/Hr for one hour then 50 ml/Hr for one hour and finally 100 ml/ Hr till the end. This drip lasted for about 5+ hours. I was comfortable and the BP was also normal throughout. At the end of an hour or so I started feeling slight itching that was progressing from top of the ears – back of the ears – below the ears under the jaws – in both arm pits and then in upper edge of the left enlarged inguinal node. This progression lasted for about 10 minutes. I had to pass urine twice during the course and had to clear bowel once. Remaining drugs were administered in less than 2 hours subsequently. Avil was injected in the beginning and Emeset was also administered but I do not remember the sequence. I had also taken Wysolone (Prednisolone) 100 mg the same day in the morning. I slept well that night.

Investigations for confirmation

Lymphoma is a malignancy in lymphatic system containing about 400+ bean-size nodes that generate a colourless liquid called lymph containing lymphocytes. Most of these nodes are housed in the region between thorax and lower abdomen, i.e. torso and few in neck, sides of face, head and groin region. The functions of lymphatic system are nicely explained at URLs http://www.cancerhelp.org.uk/about-cancer/what-is-cancer/body/the-lymphatic-system, http://www.lymphomation.org/lymphatic.htm

The investigations are mainly focused around

General health of a patient that is marked by ECG, microbiology of blood sample to see hepatitis-B, C and HIV presence.

CT scan for confirming physical evidence for enlargement in other nodes.

Haematopathology that includes, identification of various cell markers, bone marrow morphology to check whether bone marrow is also involved.

Histopathology of the blocks and slides of earlier biopsy for confirmation.

Haematopathology report shows different values of CDs which are helpful for diagnosis and planning of drugs for the doctors. All the investigations were completed in my case between 1st and 15th December.

In my case, the CT scan indicated additional enlarged nodes in both armpits and the bone marrow biopsy confirmed presence of malignancy. The lymphocytes comprise of B, T and NK cells while the investigations pointed to malignancy in B cells with a low rate of growth (indolent). I think under these circumstances all the 400+ nodes in my body are at potential hazard. Though there is no immediate danger, it is possible that the nodes near important internal organs (lungs, heart, liver, kidneys,) grow and cause obstruction to their natural function or a malignant growth in spleen or liver which are parts of the lymphatic system may cause future problems.

My B cell markers were – CD20=40%, CD22=36%, CD19=31%,CD10=25%, FMC7=36%

My Lymphoma

I was not shocked when my Doctor in Nagpur told that you have malignancy in your lymph nodes. In fact I had noticed enlargement of two nodes in the groin area (Inguinal region) of left side in February-March 2009, went to Suyash Hospital in Nashik where Dr examined, blood and X ray reports and had expressed that I better get the biopsy conducted. I thought since there is no pain or any inconvenience, it could be done at leisure.

The left inguinal node was extracted under general anesthesia. This was my first experience with GA, I was given an intravenous injection, and Doctor told me that I may fall asleep, he slightly adjusted my neck to a more comfortable position, but I am sure that I did not fall asleep. With eyes closed, I was seeing big blocks of cheese crossing my head inside, yellowish in colour, with regular perforations. My thinking process was active, I thought I am a main role in the film Matrix and things are happening around me, I was thoroughly enjoying that state though I did not have any control over blocks of passing cheese, squares of green neon rods, passing human images… I was half sitting or standing but that did not matter. All the more I was very sure that I was observing, thinking and everything was happening with my full knowledge. I was also hearing clamor of OT instruments and Doctor’s instructions to his assistants but that was only an unwanted noise. I felt an acute pang of pain when the node was pulled out but for that painful part, I thoroughly enjoyed those 90 minutes.

The biopsy report indicated: Lymphoma-proliferative – Non Hodgkin’s Lymphoma, follicular small cleaved cell type, low grade.

Immunohistochemistry is recommended (26th November 2009)