Cancer has given me tattoos and a scar that looks like I lost an encounter with a Samurai, or maybe a shark, or maybe a samurai-wielding shark.
But the only way to really become an Ultimate Macho Man is to work at it from the inside, and that means 'roids.
Even the name of the steroid I take sounds tough.
Dex: 100% MAN made
Dexamethasone is a synthetic steroid designed to mimic a steroid our bodies make called cortisol. Cortisol is a steroid released by the adrenal glands perched on top of the kidneys. Cortisol is helpful during stressful situations-- like a battle with a samurai-wielding shark-- because it contributes to our 'flight of fight' response.
Cortisol and Dex are glucocorticoids, which means they basically affect the way glucose is used by the cells in your body. During times of immediate stress (shark with sword) your body needs quick access to plenty of energy and cortisol makes this happen. Cortisol also minimises our perception of pain, boosts the immune system and acts as an anti-inflammatory agent.
Cortisol x 80 = Dex
Chemists didn't muck around when they made Dex because it is up to 80 times more powerful than cortisol. Dex also sticks around in the body longer than cortisol: its half life (the amount of time it takes to lose half of its ability to affect the body) is up to 54 hours (it's 8 hours for cortisol).
Dex is commonly used in cancer treatments to control nausea, but no one is really sure how it works. One of the fun things about having cancer is coming across treatments that work but no one knows why (there are several examples of this).
Unlike other anti-nausea drugs that directly block serotonin receptors and the main road leading to the Vomit Centre, Dex works another way; they're just not sure how, or why, or where.
Some things are known though: side effects
The list is long, but here are the most interesting ones:
- Increased appetite and weight gain (note: not muscle gain)
- Personality changes, depression
- Irritability, euphoria, mania
I now put on up to 1 kg a week of body mass, I wrote this article at 3:40 am, I got anxious today about something small, I breakout in a sprint when cycling for no reason except that I can, and when my thoughts start racing, they're matched only by my racing heartbeat.
But I haven't vomited once.
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I'm part way through treatment for a sigmoid tumour that had invaded the rectum and have been treated as if my cancer was rectal.
I've had chemoradiotherapy and surgery and am now having adjuvant chemotherapy. The period around diagnosis until treatment starts can be stressful. I've met many people who become impatient and want to rush everything forward. If cancer has taught me one thing, it is to slow down, enjoy the health your body now has, celebrate all that is healthy about your body, breath.
Good luck with it all, if you want to direct message me at any time with specific questions or thoughts go for it.
PS Don't be too worried about the 'ostomy' words. They sound scarier and more gross than they actually are, I have an illeostomy and actually kinda like it ;)
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Yep, total Dex. Dex is an interesting anti-emetic because (like a lot of things related to cancer treatment), the oncs aren't sure exactly how and why it works. Unlike Kytril, which is often given with Dex, where it is known to block 5-HT3 receptors in vagal nerves.
What did Dex do you to?
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Looking at or smelling chemotherapy drugs don't make you feel sick; they have to be inside the body to cause nausea and vomiting. And this doesn't involve the stomach (well, not at first, the vomiting bit is all stomach), it involves the small intestine.
Because cells lining the small intestine are particularly sensitive to chemotherapy drugs.
When these cells are damaged by chemotherapy drugs, they release the neurotransmitter serotonin. The name serotonin is loaded with meanings related to happiness in people and bullying in male animals, but around 90% of serotonin in the human body is found in cells lining the gut, where it has the mundane job of regulating how fast the digestive system pushes food along.
Three roads lead to vomit town.
The main road
Serotonin released by intestinal cells damaged by chemotherapy drugs is detected by vagal nerves hanging out near these cells. Vagal nerves send information (WARNING: Gut has been poisoned) to the medulla oblogata, the region of the brain where the Vomiting Centre is located. Then you feel sick and vomit.
The small side road
Serotonin released by upset intestinal cells enters the blood stream, chemoreceptor trigger zones detect it and alert the Vomiting Centre that something isn't right (WARNING: High levels of serotonin in blood stream mean gut is poisoned). Then you feel sick and vomit.
The smaller side road
The chemo itself is directly detected by the chemoreceptor trigger zones that alert the Vomiting Centre (WARNING: Poison in blood stream). Then you feel sick and vomit.
Controlling the flow
Oxaliplatin is a non-targeted chemotherapy drug and a part of my treatment. It is especially emetic, meaning it causes nausea and vomiting (emesis) in nearly everyone that has it. It even causes nausea and vomiting when given to patients in combination with super duper drugs that stop nausea and vomiting.
Drugs that try and stop nausea and vomiting act as road blocks along the streets that lead to vomit town. I'm a particular fan of one of these drugs, a steroid, because I now put on one kilogram of weight a week, have bouts of anxiety, and suffer from insomnia.
I refer to these side effects collectively as Roid Rage.
Original blog post here.
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Vomit Centre is perhaps the coolest name of any part of the human body.
It is located in the stem of your brain, in an area called the medulla oblongata. The medulla oblongata is old, meaning it is also found in the brains of other critters not so closely related to humans, such as fish. Old parts of the brain tend to do the the really important stuff that animals with brains have been doing for millions of years, such as breathing and maintaining a beating heart.
The Vomiting Centre collects information from across the body and when this part of the brain becomes excited (in the neurological sense, not the 'I can't wait for the next episode of True Blood' sense) people vomit.
Signals INTO the Vomiting Centre
From other parts of the brain: You know these parts are talking to the Vomiting Centre when you want to vomit because you see someone else vomit. Or when my Nanna smells really ripe bananas and her stomach tries to empty itself.
From organs: You know organs are talking to the Vomiting Centre when you eat so much that your stomach expands and you throw up. Or when you have an intestinal blockage and you vomit.
From the inner ear: You know when your balance system is talking to the Vomiting Centre when you get get off a roller coaster feeling very dizzy, and vom.
From chemoreceptor trigger zones: These trigger zones are also in the medulla oblongata. They detect chemical abnormalities and poisons throughout the body, meaning it's chuck time.
Signals OUT OF the Vomiting Centre
Regardless of how the Vomiting Centre becomes excited (spending too long on a roller coaster, blocked intestine, being vomited on) the final action is the same: vomition.
Why does chemo = nausea and vomiting?
The way chemotherapy drugs make the body vomit isn't as straight forward as you might think. The next blog post will explain why chemotherapy makes the body vomit.
And it doesn't involve the stomach (well, not at first, as we all know the act of vomiting is ALL stomach).
This blog was re-posted from here.
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I'm slowly morphing into a higher human. Something half man, half medical apparatus.
The latest addition to my collection is a clever piece of latex designed to protect a PICC line from the evils of water.
It will replace something I now use and which I call The Plastic Bag With Rubber Bands.
See me wearing my new toy here
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'Go home and rest' is old advice. It's outdated.
Last month Macmillan Cancer Support released the Move More report. They wanted to remind patients that exercise can help increase their chances of survival, often better than any drug can.
'...if physical exercise were a drug, it would be hitting the headlines.'
Macmillan claims that 'taking it easy' during treatment should no longer be the line given by doctors. It seems that exercise does not increase fatigue during treatment, but does increase energy.
The bigger and better benefit
People with cancer that exercise live longer than those that don't, and their cancers are less likely to come back compared to people who 'take it easy'.
Amazing. This is something I can do, no hospital machines or needles required.
For my cancer in particular I can reduce the chance of it coming back AND my dying from it by 50%. F-i-f-t-y p-e-r-c-e-n-t!
Imagine if your oncologist came to you and said 'We have a new medication, taking it means the chance of you seeing your 30th birthday will be 50% higher. Oh, and it will also improve your brain, circulation, muscle tone and cardiovascular system. There are no side effects. Do you want to try it?'
Of course you would.
Exercise during cancer treatment is not easy. The number of times my bag has misbehaved at the gym and the 15% (14 kg) of my body weight I lost while in hospital means I know this first hand. But I want to live as long as possible (that turns out to be quite a motivator) and so I exercise nearly every day.
Colorectal cancer is greedy
My cancer requires one of the highest exercise regimes to get the best results: 6 hours per week. That's 360 minutes a week, or 51 minutes a day. Sounds like a lot doesn't it?
To get my quota each day I try to combine exercise and my appointments (cancer patients have a lot of appointments). I ride my bicycle when going to see the hospital psychologist. I jog to my acupuncture sessions. I walk down to the juice bar to get my daily hit of liquid veg.
Count your METs
Research in this area uses a thing called the Metabolic Equivalent Task. MET equals 1 when you are sitting and resting. Doing an activity with an MET of 4 means you are using four times the energy and oxygen that you would if you were resting. A list of the activities and their METs is here.
18 METs per week appears to be the magic number for colorectal cancer. But it is dose-dependent, which means even if you do 5 METs you still get some benefit. 12 METs benefits you a little more. 18 METs and above gives you the most benefit, cutting the chances of recurrence, and that other nasty thing that we don't like to talk about, by up to 50%.
Links to the report can be found at: http://benbbrave.blogspot.com/2011/09/every-step-counts.html
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The immune system is involved, but immune systems are complicated and the cell dynamics and biochemistry involved hurt my brain.
I'm not sure if terms like 'good' and 'strong' really apply to immune systems. Indigenous Australians for example would have had 'excellent' immune systems wholly adapted for the tough Australian continent and live outdoors, but then exposure to simple chicken pox took the lives of thousands of individuals.
Our immune systems are constantly adapting and learning. Its primary role is to recognize 'self' from 'non-self' and remove the non-self bits that pop up. These non-self bits can be bacteria, viruses, or cells that look and behave differently (ie. cancer cells).
Cancer actually hijacks a part of the human body's immune response and can recruit and then convert your immune cells to stop working for you and start working against you. That is why cancer is so dangerous - it uses complicated biochemistry to turn immune cells that were sent to destroy it into cells that then help it grow and spread.
This isn't a sign of a 'weak' immune system, it's a sign of a clever disease. And cancer can be considered very clever: 1 in 2 or 3 (depends on the report you are reading) people will get some type of cancer (ie. cells that grow into a tumour that the body has not removed).
There are so many types of cancer cells and cancer cell lines. Your body has been doing a good job removing cells with the potential to turn into cancer (cells that weren't copied correctly for example) since the moment you were conceived. And yes, it has been fighting colds and cuts that entire time too. Some places suggest that weird and potentially dangerous cells are produced over 10,000 times a day - you have never noticed this though because your immune system has been hard at work keeping things clean and tidy.
All it takes is one cancer cell to outsmart your immune system and avoid removal and however 'good' your immune system was until that point means nothing. Once your body fails to recognise that group of cells as 'non-self' your immune system has lost. It will still continue to fight all the things it has learnt to fight though such as colds and infections from cuts.
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Cancer Council NSW would like to acknowledge the traditional custodians of the land on which we live and work.We would also like to pay respect to elders past and present and extend that respect to all other Aboriginal people.