Genetics Testing for Breast Cancer and the BRCA2 Gene Mutation

If breast cancer happened at an early age, or if there is a history of breast cancer in the family when you got the news, then your oncologist may recommend genetics testing. My oncologist suggested a visit with a genetics counselor as I was diagnosed with triple negative breast cancer in my early 40s. Turns out, I tested positive for BRCA2 gene mutation.

flowers

This post will go into things to consider for genetics testing, as well as info I learned about the BRCA2 gene mutation along the way. I had to take time in writing this, as it still gets to me. Like, a lot. It is one thing to be diagnosed with breast cancer; it is something all together different to know that each of your kids has a 50% chance of getting it and passing it on. It’s the emotional weight of the diagnosis that is the most painful. I can take all the measures for fighting for myself, but a parent never ever wants to be in the situation to pass on news like this to their kids. It’s awful. I’m waiting until my kids are older to tell them. And I need to get to the point of being okay with it to explain it all to them, so I’m glad they are young. 🙂

Genetics Testing for the BRCA1 and BRCA2 Gene Mutation

Every woman who has breast cancer shouldn’t worry if they carry the gene mutation as BRCA1 and BRCA2 mutations make up actually only a small portion of breast cancers.

Both the BRCA1 and BRCA2 gene mutations are damaged genes that are passed on through the family lines which places the carrier at a higher risk for getting certain cancers in their lifetime. It could come from either side (your mom or your dad’s side), and dads can pass it on to their daughters so don’t think it is only a maternal gene.

Questions for At Risk Women and Who Should Consider Genetics Testing

The answers to these questions will help determine if genetics testing should be considered.

  • Was your cancer diagnosed at an early age? Was it triple negative breast cancer?
  • Was it bilateral breast cancer?
  • Do you have an Ashkenazi Jewish background?
  • Is there breast and/or ovarian cancer in your family background?
  • Is there triple negative breast cancer in the family diagnosed at age 60 or younger?
Benefits of Genetics Counselors

My personal recommendation is to see a genetics counselor first. The advantage of seeing an actual genetics counselor is that that person will literally spell out every detail regarding the genetics testing, and answer any questions you have. They are experts in the field of DNA and genetics and they can explain in detail what gene mutations are. The genetics counselor will actually help you decide if the testing is needed for your case, too, and will help you go back through your family history to see if there is a pattern if you are unsure whether BRCA1/BRCA2 exists in your family. In my case, my genetics counselor through Kaiser was amazing. She was very thorough in her quest to see if this was right for me, answered all my questions (and there lots especially when it came to my children), and was patient and kind in giving me, at the time, the pretty devastating news. I now consider the news a great benefit as I have tailored my breast cancer therapy around it. 

Other gene mutations can cause breast cancer, though, so screening for inherited mutations for genes other than BRCA1 and BRCA2 may be recommended.

Reading the Results

You can be positive, negative, or be a variant of uncertain significance. Positive means there is a shift in the gene code and will be reported as pathogenic. Negative means no variation was detected. Variant of uncertain significance means there is a mutation but isn’t enough to classify it as fully positive (don’t think of it as a positive). If you are negative, you are normal. If you are positive, you are considered a carrier.

Remember: just because you test positive doesn’t mean you will get cancer, and just because a family member tests positive, doesn’t mean that you will, too. Also, just because one person in the family tests positive, it doesn’t mean the entire family will test positive.

Benefits of Genetics Testing

The main benefit of testing and finding out you are negative is you can relax a little about the risk of future cancers and passing it on to your kids. The main benefit of testing and finding out you are positive is that you can be proactive in your cancer journey with drugs and prophylactic surgeries to prevent future cancers from forming. It also gives you a little relief in knowing there is a reason you got cancer in the first place rather than constantly wondering what you did, ate, or exposed yourself to that was the cause. Meaning – there is a genetic explanation of why you got the cancer. If you are positive but have no cancer yet, you can begin your screening for breast cancer at a much younger age than the general population. That is always good news to detecting and treating it early.

Emotional and Psychological Drawbacks of Genetics Testing

This is something personal and will affect different women in different ways. Testing positive will be overwhelming to say the least. And if you have kids, like in my case, this may be the most difficult thing to tackle and deal with, just knowing that you are the reason they may have an increased risk of developing cancer. But remember (as I have to remind myself) it isn’t your ‘fault’. It’s just genetics, baby.

And then you have the task of telling family members and having them react to the news – they will be in two camps: positive and proactive, or filled with anxiety. Remember, this news is private and only you need to deal with it at first. Deal with it first in your own way before you share the news with others.

BRCA2 Positive: What This Means

What is the BRCA2 Gene Mutation?

As I am BRCA2 positive, I will not go into BRCA1. It’s a whole other can of worms that, since I’m negative, I don’t need to open. Basically, we all have the BRCA gene, and the BRCA gene functions to keep cancer from forming in the breast. When a mutation forms it doesn’t work properly, thereby increasing your risk for developing breast cancer. BRCA1 and BRCA2 are two different mutations of the BRCA gene. The BRCA2 gene is located at chromosome 13. If you are BRCA2+, it means there is a mutation for that gene at that spot, and you are at an elevated risk of developing some cancers.

My genetics counselor told me if there was a choice of BRCA1 or BRCA2, then it would be better to be BRCA2 positive. It usually strikes later in life (except in my case lol), and it is easier to treat, or rather, responds better to therapy. I’ll take any good news I can get.

The Basics of BRCA2 Positive

The most commonly associated cancers with this genetic mutation are breast, ovarian, pancreatic, prostate, melanoma, and endometrial serous carcinoma – a rare form of endometrial cancer. The BRCA2 mutation is also called Hereditary Breast and Ovarian Cancer Syndrome.

What are the odds of someone testing positive and developing a cancer? This is from the company who did the genetics testing for me:

  • 41% to 84% risk for breast cancer in women, and 4% to 7% for breast cancer in men.
  • 11% to 27% risk for ovarian cancer.
  • 5% to 7% risk for pancreatic cancer.
  • 20% to 35% risk for prostate cancer.
  • Your chances of melanoma skin cancer is increased.

What are the chances of passing it on?

  • First degree relatives have up to a 50% chance of also having this mutation, which means your kids have a 50% chance of getting this mutation from you, male or female.
Managing Your Risks When BRCA2 Positive

There are a number of ways to use this information in a proactive way. They involve either increased screening or prophylactic surgery.

When you are in your twenties, it is recommended for women to have an MRI or mammogram every other year, then every year after 30. Clinical breast exams by a doctor should be done every 6 months to a year, beginning at age 25. Self exams should be done monthly beginning at age 18 – this is important so that you can notice changes to your own breast early. Full body scans for melanoma cancer should be done. Wear sunscreen and hats and protect yourself from the sun! (Of course, you are doing that already.)

Bilateral mastectomy before cancer develops will reduce the chance of developing breast cancer by at least 90%. I asked my surgeon why it doesn’t just move to 100% since the breasts are removed, and he said since breasts are made of mammary glands and not actual muscle, it is nearly impossible to remove all breast tissue. But 90% is a very good number. If you have had all your kids and you are between the ages of 35 and 40, removing the ovaries and fallopian tubes will reduce ovarian cancer and if done before natural menopause further reduces the risk of breast cancer by up to 50%. Tamoxifen, a hormone therapy, reduces the risk for estrogen responsive cancers.

The Bottom Line With a BRCA2 Positive Diagnosis

…is that it is not the end of the world. Rather, it is the beginning of taking a heightened look at what you are doing for screening and what you can do to prevent a cancer from happening in the first place. At first the news can be devastating, especially when kids are involved, but knowing all the facts makes knowing this news actually beneficial. And since the point is to be around for a long time to come, knowing whether you are positive or negative is something important to know.

Image of flowers courtesy Henry Lorenzatto via unsplash.

Tamoxifen: Reducing Your Chance of Getting Breast Cancer

What is tamoxifen?

Tamoxifen is a hormone therapy for breast cancer, and works as a preventative for people who are at high risk for developing breast cancer.

Sand and Succotash | Tamoxifen Structural Formula

SERMs – Agonist-Antagonist Properties

Tamoxifen acts as an agonist-antagonist where estrogen is concerned on different parts of the body.

Tamoxifen citrate is a ‘selective estrogen receptor modulator’, or SERM for short. SERMs act as estrogen antagonists binding to estrogen receptors, and preventing estrogen from binding in the breast. But SERMs conversely act at the same time (‘selectively’) as estrogen agonists on the uterus. Meaning while it significantly decreases the occurrence of breast cancer, it increases the chance of getting endometrial and uterine cancers.

Tamoxifen and Triple Negative Breast Cancers

Triple negative breast cancer is a type of cancer that tests negative for all three hormone receptors (estrogen receptor-negative, progesterone receptor-negative, and HER2-negative) therefore tamoxifen will not help with this cancer since triple negative cancer isn’t estrogen based.

My breast cancer is triple negative, but my oncologist prescribed me tamoxifen because I’m BRCA2 positive. She figured it wouldn’t hurt to have this level of protection to prevent an estrogen based breast cancer from occurring during the time between the end of chemo and the date of my double mastectomy.

Drug Interactions

Certain drugs may interfere with the potency and effectiveness of tamoxifen. Drugs that inhibit the enzyme CYP2D6 all do this. The enzyme CYP2D6 is needed to break down tamoxifen into molecules, or metabolites, which activates it. These drugs include SSRI antidepressants (selective serotonin reuptake inhibibors) such as Paxil, Prozac and Zoloft. Other common drugs that interfere with this enzyme are diphenydramine (Benedryl, an antihistamine), quinidine (Cardioquin, for abnormal heart rhythm), and cimetidine (Tagamet, reduces stomach upset). Also, people who have abnormal CYP2D6 enzyme function may not get the full benefit of tamoxifen, either.

Benefits of Tamoxifen

Tamoxifen has been proven to lower the chance of high-risk women getting breast cancer, and lowers the chance of the cancer metastasizing, or spreading, for women who currently have ductal carcinoma in situ – meaning breast cancer found only in the milk ducts. Tamoxifen reduces the risk of a new cancer developing in the other breast when cancer was only found in one breast. It can also help shrink large hormone-receptor cancers before surgery.

Risks of Tamoxifen

There are risks with using tamoxifen. The main ones are hot flashes, mood swings, loss of libido, and night sweats. Since this tamoxifen is an estrogen agonist in the uterus, there is an increased risk of developing endometrial and uterine cancers. This side effect increases with use, so the typical prescription for this drug is 5 years tops. Other side effects are blood clots and stroke.

Women who are pregnant or nursing should not take tamoxifen as the drug may damage developing embryos. Women of child bearing age should use non-hormone contraception (condoms, diaphrams with spermicide, and IUDs) for two months following tamoxifen use. Also, women who are breastfeeding should not take tamoxifen as it may pass through the milk to the baby.

 

 

 

Breast Biopsy Procedures

If a lump is discovered, then the next probable course will be to get a biopsy done to determine what it is. In most cases, lumps are benign (a cyst for example). If you need a biopsy, here is what you need to know.

Differences in Breast Biopsies

There are different biopsies that can be done to determine what the lump is, and if it is cancerous, whether or not the cancer has spread. I had two: a breast core biopsy (which determined that I, in fact, had breast cancer), and a sentinel lymph node biopsy (which determined that no cancer was found in my lymph nodes).

Breast Core Biopsy or a Core Needle Biopsy

This biopsy is done by a radiologist under local anesthesia with the guidance of an ultrasound. This differs from a simple needle biopsy as the needle is larger, and is hollow to allow for more tissue to be removed at one time. Since more tissue is removed the results are more accurate.

The ultrasound is used to help identify what the lump is and where it is located in the breast. When I had my mammogram, my radiologist didn’t like the look of one of my lumps so he strongly advised an immediate biopsy (he literally said to me, “I don’t like the look of this one”). So, I had an immediate core needle biopsy right there. I had three lumps in my breast, one of the lumps was the one I was concerned about, and two very small ones that I didn’t even know were there. The two small ones turned out to be benign cysts.

Breast Core Needle Biopsy Procedure 

First thing, the area of concern is identified on the ultrasound. Second, the area where the radiologist will remove the tissue will be numbed with local anesthesia – expect this to hurt a little. You won’t feel the actual needle removing the tissue but you will feel these smaller needles and they do pinch. The tissue samples will then be removed with a thicker needle that can accommodate larger tissue samples.

During the procedure you will hear a series of clicks – that is the needle removing the tissue at the site. After this procedure, you will be a little sore around that area. I had some bruising, and some bleeding at the cut sites (they tested more than one lump) but they healed up quickly.

Sentinel Lymph Node Biopsy

The sentinel lymph node biopsy is done a little different, and it will be under general anesthesia, meaning you will be put under. A radioactive substance and a blue dye will be injected near the actual cancerous tumor site, and where ever it first travels to is where the sentinel lymph node is.

What is a Sentinel Lymph Node?

A sentinel lymph node is the first single lymph node, or grouping of lymph nodes, that could indicate that a cancer has spread as this is where the cancer first travels to if it has traveled at all. A lymph node’s job is to assist the body in the removal and filtration of toxins, bacteria, and cancer cells.

After the sentinel lymph node biopsy, you will be either node-negative or node-positive. Node-negative means that there was no cancer present in the first lymph nodes that the dyes have traveled to.

Sentinel Lymph Node Biopsy. Image courtesy Cancer.gov.

Sentinel Lymph Node Biopsy. Image courtesy Cancer.gov.

The Sentinel Lymph Node Biopsy Procedure

You will be asleep during this procedure. In my case, I had one doctor inject the radioactive substance and the dye into me, and another surgeon doing the actual following of the path and removal of the lymph nodes. Both substances injected in you will help to identify the lymphatic path – the radiocolloid makes the path accurate and the blue dye helps to easily see it. The radiocolloids used in this procedure will stay in the sentinel lymph node, and any remaining radioactive substance lingering in your body will soon dissipate so you shouldn’t worry about yourself glowing at nighttime.

Once the single lymph node (could be a cluster of lymph nodes depending on your body’s path) is identified – the radiocolloid and blue dye will follow the same path to the first lymph node – then that lymph node is removed for further testing. If there is no cancer present, it is referred to as node-negative, and it means that no cancer was found in the first lymph node and has not spread to other lymph nodes. If there is cancer present in the sentinel lymph node, it is referred to as node-positive, and it means there is a chance the cancer has spread to other parts of the body via the lymphatic system.

Benefits and Side Effects of Removing Lymph Nodes During Sentinel Lymph Node Biopsy

The major benefit of this biopsy is to identify if the cancer has spread. When the lymph nodes are identified with the radioactive dye, they are removed. If it is just the one, then only one lymph node is removed. If multiple lymph nodes look suspicious or are colored, then they will be removed at this time.

Side effects of this procedure will be swelling at the site, bruising, and soreness. You will have a definite scar from the surgery right under the arm at the breast. If many lymph nodes are removed you may end up with lymphedema, which is the build up of lymph fluids.

For more information on my breast cancer path and how it may help you if you are going through it, visit

Oysters for the Cure: Pink Ribbon Oysters

Need fresh oysters, and want to help in the fight against breast cancer? Pink Ribbon Oysters would be the way to go. Since I’m currently in the fight, I love this idea. Pink Ribbon Oysters come out of Long Island, and 25% net revenue of each oyster sold is donated to the Breast Cancer Research Foundation.

pink-ribbon-oysters

Image courtesy Pink Ribbon Oysters.

Read about them over on Dana Point Fish Company, or donate directly to them at the Pink Ribbon Oyster fundraising page.

Chemotherapy ACT Treatment for Breast Cancer

ACT chemotherapy is an anagram for the three different drugs that are used in the treatment for breast cancer: Adriamycin (Doxorubicin), Cyclophosphamide (Cytoxan), and Taxol (Paclitaxel). It is often listed as AC + T as the first two drugs are given first at the same time followed by the third. Here is what you need to know if this is what you are prescribed.

What Is ACT Chemotherapy Treatment

ACT treatment for breast cancer is a combination of drugs that when used together can work effectively in the fight with the beast that is cancer. This chemo cocktail lowers your bone marrow’s ability to make blood cells, so your oncologist may prescribe an injectable medication to increase your white blood cell count.

The Doxorubicin part is a vein vesicant and will cause tissue damage if it somehow leaks from the vein. Your oncologist may order you a PICC line to be installed – this is to protect the veins and tissue from damage. While uncomfortable when first installed, a PICC line makes the rest of your chemo treatments a breeze. Doxorubicin is red, and is often referred to as the ‘red devil’. It’s very strong and will turn your urine a reddish color after chemo (doesn’t last long and is gone a few hours later).

You will need to go in for labs to check your blood work to make sure you are healthy enough to handle another round of chemo. This will be done the day before chemo or right before chemo, and if something doesn’t look stellar, then your chemo may be rearranged to make sure you are well enough. This is done with each round.

Chemo brain. Yes, there is such a thing, and yes, you will suffer from it. Your short term memory will be gone and little things like creating shopping lists will become the bane of your existence. For me, this was a profound effect. Three times I literally lost my car in the parking lot of the local grocery store. And I always tried to park in the same area. But when you exit the building and completely are in a fog, then you are pretty much done for. Write things down because you will forget them, things like dates, times, places, etc.

Side Effects of AC Chemo Treatment (Adriamycin/Doxorubicin and Cyclophosphamide)

Immediate side effects are nausea, nausea, and more nausea. The day of chemo, the chemo nurses gave me a mild sedative (I always fell asleep during this treatment for about an hour) as well as antinausea meds. I was given three different prescription medications to counteract this side effect at home so that this side effect was kept at bay for the most part. I was prescribed Olanzapine, Zofran, and Compazine. I took these all at the same time after each treatment. I took Olanzapine once a day on days 2-4 after chemo (chemo being day 1), Zofran twice a day on days 2-4 following chemo (then as needed), and Compazine every 8 hours as needed whenever I needed it. From experience, if you can keep the nausea to a minimum then your days will be so much better. My oncologist gave me a prescription for dissolvable Zofran, too, for days when I didn’t want to wait for a drug to work (mild minty flavor which was suitable to me and provided instant relief).

Expect your hair to fall out. I actually thought that I might be spared this side effect as I still had my hair during the second round, but one day my scalp was super itchy, and a few days later it was all gone. And not just the hair on top of your head, but your eyelashes, eyebrows, your nose hairs, and every place else. For whatever reason, the fine hair on my forearms stayed but everything else was gone. You can wear a wig if you want, go au naturel, or wear a cap like I did.

Your fingernails will grow darker, and will grow out weird. From experience, just expect your nails to look awful, slap a coat of polish on them, and you’ll be better for it. Mine had a strange rounding to them instead of just growing straight, were really brittle, and had these horizontal grooves in them. Once you stop with this part of the chemo, then your nails will begin to grow back normal.

Other side effects that I didn’t have that you may have: heart issues, thrombocytopenia (bleeding due to low platelets), and mucositis (mouth sores). The heart issues can happen during treatment or months to years afterward (I’m hoping I never have future heart issues because of the Doxorubicin). Use a soft tooth brush to prevent bleeding of the gums. If mouth sores do develop, avoid rinses with alcohol. You may be prescribed a special rinse to help you with your mouth sores, such as ‘magic mouthwash’. There are different recipes a pharmacist can mix up for magic mouthwash; mine was a Diphenhydramine Lidocaine Maalox mixture. I never got mouth sores, thankfully, or had a bleeding problem during chemo. But I had this concoction in my refrigerator just in case.

Side Effects of Taxol Treatment (Paclitaxel)

This drug has its own side effects, and peripheral neuropathy is the major one to be concerned about. Peripheral neuropathy causes problems with the nerves in your hands and feet leaving you with a tingling or burning sensation, or can lead to numbness to these areas. For me, it affected my feet in a weird way. It made them ‘squishy’ for lack of a better word. The bottom of my feet lost feeling periodically which made walking sometimes a challenge (I just watched where I walked). To counter this side effect, my oncologist suggested three different over-the-counter medications to try: Nerve Support, Nerve Shield, or Alpha Lipoic Acid. I took the Nerve Shield and I think it helped with my feet tingling and fingers numbing up.

During this part of chemo your oncologist will often ask you how your pinching action is, how you are at buttoning up your shirt, or even how texting is. Fine motor skills will be affected as well as your ability to grasp things. To help prevent pain to the fingers or feet, avoid really hot or really cold water, and always wear nonskid shoes. Going barefoot increases the likelihood of you stepping on something without feeling it. The effects accumulate and can actually worsen with each treatment. For the most part, all feeling goes back to normal after a period of time following the last Taxol treatment. But, unfortunately, if it gets too bad then the symptoms become irreversible, which is why your doctor will be so interested in your finger action.

You will not be as nauseous with this part of the chemo trio, but Paclitaxel calls for a whole new set of pills to take. Taxol can cause severe allergic reactions, so to limit this, I had to take 1-10mg tablet of Zyrtec one hour before chemo, 2-20mg tablets of Famotidine (Pepcid) one hour before chemo, and 5-4mg tablets of Decadron the night before and 5 more two hours before chemo. The Decadron is a steroid so a word of warning, you will be UP the night before chemo these days. I really had a tough time sleeping when I took Decadron.

Other Side Effects of ACT Chemo Treatment

Fatigue

You will be extremely tired and fatigued, not just physically but emotionally as well. To help counteract this, just limit yourself of your obligations. I sadly resigned as PTA Secretary (which I enjoyed) and stopped my volunteer involvement with my kids’ running club and classroom work (which I loved). It was very hard to quit before chemo when I was well, but I soon realized after chemo started that there was no way I could handle everything like I did before. As your chemo goes on, your periods of fatigue may last longer and longer. Just know your limits and try doing things to reduce your anxiety and stress levels as much as possible. If you have anemia (see below) then this may compound your fatigue.

Constipation and Diarrhea

Chemo can play havoc with your digestive system by having a negative effect on those healthy cells inside your bowels. These two things can pop up within days of each other, too. For constipation, docusate sodium is a mild over-the-counter remedy. Colace is another good medication. Eating foods high in fiber and drinking enough fluids will also help. For diarrhea, eating smaller meals for often, and making sure you drink enough fluids. Imodium AD is an over-the-counter remedy for this side effect.

Dry Skin

Your skin will be itchy and dry, so a good moisturizer will be your good friend. You have cancer and are undergoing chemo. Indulge in something nice. 🙂

Anemia

Anemia is caused by low levels of red blood cells. Make sure you eat a well-balanced, protein rich diet. Dark leafy greens, beans, and peanut butter are all good choices here. Rest when you can, and often if you are anemic, and try to get at least 8 hours of sleep each night.

Neutropenia

Neutropenia is a noticeable reduction in white blood cells. Unfortunately, this has no real symptoms until you are ill. That is why blood tests throughout your chemo course is so necessary. If your temperature goes any higher than 100.4 anytime during chemo then it is off to the hospital. My oncologist prescribed me with injectable medication to be taken at home after each round of chemo to specifically prevent my white blood cell count from plummeting.

Excessive Tearing

Your eyes will be extremely watery, and will constantly tear up. Wearing sunglasses whenever you are outside helps to protect them from the wind – which causes more tearing and watery eyes – as well as protection from the sun.

Fertility Issues

Your period will stop during this chemo concoction. Ask your doctor about menopause symptoms, which you may get: hot flashes, night sweats, mood changes.

PICC Lines: What They Are and How to Care for Them at Home

PICC line stands for “peripherally inserted central venous catheter” and it is an intravenous port inserted between the elbow and the shoulder. PICC lines are used for a variety of reasons, but in my case since my chemo concoction was a vesicant, I was required to get a PICC line installed to protect my arm and veins.

PICC lines require daily maintenance at home, weekly maintenance with your doctor or nurse, and you really have to adjust everything you do around them to ensure they are in perfect working order. But, if you are having chemotherapy, they are a cinch during treatment – you don’t have to worry about the nurses trying to find a vein every single time, and they make your lab work a breeze.

Picc Line

Typical PICC Line Components.

Installing PICC Lines

Installation for a PICC line isn’t fun, but it isn’t the end of the world either. At most, you will feel a heck of a lot pressure on your arm for the next 24 hours after it is in, but that feeling goes away. It started out with a specially trained medical professional (I had the best nurse doing mine) identifying the major veins in my left arm via an ultrasound. Once she set her sights on a vein she liked, she made my arm sterile, put a tourniquet on, and then numbed the area of insertion. This needle was actually the worst part of the procedure.

My nurse then threaded the tube from the insertion point all the way to the main vein leading to my heart via the ultrasound. An x-ray was done afterward to ensure it was placed correctly. I think the pressure that I felt in my arm for the next several hours was due to the tourniquet that was in place during the PICC line installation. The PICC line itself gave me no pain or feeling at all.

What the PICC looks like when completely installed.

What the PICC looks like when completely installed.

Care for PICC Lines

PICC lines are pretty easy to care for, really, you just need to be careful around it. You will probably come home with a clear dressing on it, like I did, that held down everything nicely. I had a mesh sleeve around it to keep it from flopping around. You will need to avoid heavy lifting on that arm, no swimming or baths, and it needs to be kept dry at all times.

Every week the dressing needs to be changed. The nurses who do this are typically highly skilled. Once the old dressing is removed, the entire area is cleaned with a cleaning solution (chlorhexidine, iodine, etc.). I was at first given chlorhexidine to clean my arm but it irritated my skin so they switched to the messy brown iodine. After it is all cleaned and the area of insertion is tended to, a clean clear dressing is placed over it, keeping the end free and clear. The injection cap is typically changed at this time, too.

Daily flushings with saline are necessary. I was given sterile plastic syringes that screwed in the end of the PICC lines to flush it. This kept the lines clear to prevent blood clots since I had chemo every other week. Oddly, at every flush, I could ghost taste the flavor of the saline. Crazy stuff. The chemo never had a taste but with each flushing, I had the odd alcohol flavor come into my mouth.

Tips for Showering

The dressing must not get wet under any circumstances. So, baths are obviously out. And unless you shower with one arm in / one arm out of the shower, you need to find a way to keep it dry. Ok, what I’m about to tell you worked wonders for me. I purchased Glad Press’n Seal plastic wrap and wrapped this around my arm. I actually used this same stuff years ago to lay on the dining room table when my kids were doing anything messy that needed a quick clean up (painting with brushes or fingers, gluing stuff on their own, etc.); I just placed this sticky side down when they worked, and then easily removed the mess when they were finished.

This plastic wrap has a slightly tacky side that gently adheres to whatever it touches. My PICC line had a dressing covering that needed to be kept dry at all times, so whenever I showered I took enough from the roll to wrap around my arm twice and pressed to stick. In the 4 1/2 months I had the PICC line in, my line didn’t get wet in the shower once with this method.

Things to Call Your Doctor For When You Have a PICC Line

The risks are low with a PICC line, and as long as it is kept clean and dry and you are careful around it, you shouldn’t have to worry about your PICC line. Having said that, call your doctor if you have major pain in your arm, have a fever, there is bleeding at the insertion point, or if the area is warm or red or there is swelling in the arm or hand of the PICC line. These are all highly indicative of an infection.

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Images courtesy Wikimedia Commons through a creative commons license.

The Meals to Heal Cookbook by Susan Bratton and Jessica Iannotta

Cancer is hard. Cooking and trying to balance nutrition with what tastes good during cancer treatment is even harder. I know this from experience fighting breast cancer and undergoing a dose dense ACT chemotherapy. Nothing really tastes good during chemo, you have no energy to cook, and at times it is much easier to choose comfort food over what you probably should be eating.

Cooking During Chemo

I am lucky. During my dark days of chemo where I couldn’t get out of bed and my husband worked long hours, I had a dedicated group of moms who would make nutritious and great tasting meals for me and my kiddos. The rest of the time, I had to get off my tush and figure it out. And easy it was not at times, when even food ingredients themselves make you sick to your stomach.

Recipes you need during cancer treatment: ones that nourish you from the inside without giving you stomach or mouth upset. Those with strong smells can make you nauseous, and beloved spicy foods that once brought comfort can otherwise ruin an already small appetite simply by making your mouth drier than it already is.

The Meals to Heal: Great Tasting Recipes that Address Cancer Symptoms

The Meals to Heal Cookbook by Susan Bratton and Jessica Iannotta tackles all these problems and presents 150 recipes to prepare during a cancer fight. Each recipe is marked with what side effect it helps to manage: lack of appetite; nausea, vomiting, or heartburn; constipation; diarrhea; fatigue; mouth sores; dry mouth; chewing or swallowing difficulty; taste aversion (to sweet, or sour and bitter); lack of taste; and smells bother.

I took a chemotherapy class before treatment and quickly learned that there was a whole list of favorite foods I had to avoid during treatment, such as bulk bin ingredients and deli meats, miso (fermented soy paste) and tempeh (what?!), and raw foods including any fruit and veggie that I couldn’t scrub clean. Looking at the list of foods to avoid that your oncologist gives to you isn’t the end of the world. You just need the right recipes using the right ingredients that you can use. The Meals to Heal has recipes for everything from beginning your day with healthy breakfasts to entrees and midday snacks to good sweets for dessert.

The authors dedicated Part 1 of their book to making food work for your benefit, even titling it “Getting Started: Food Can Change Your Cancer Journey.” Safe food handling tips and nutrition info is at the back of the book along with a wonderful appendix that identifies in chart form which recipes help with a certain symptom or side effect. This part I found to be very helpful as I could easily choose a perfect recipe for what I was experiencing. For example: looking for a soup when you are constipated from pain meds, have a dry mouth and an aversion to anything sour and bitter, have heartburn, AND strong smells bother you? Then, the Orzo Kale Soup would be a perfect match. Enjoy. Love that.

If you are on a cancer treatment path that includes chemo, then this is the perfect book to have in the kitchen. No empty promises for an easy ride through treatment (because there isn’t one), just real world, wholesome recipes that provide nutrients making you stronger – and presented in a way that tackles your side effects and manages your symptoms. Highly recommended read.

Enjoy a recipe from this great cookbook: Paper Steamed Fish and Vegetables.

Paper Steamed Fish and Vegetables | Sand and Succotash.com

Parchment Paper Steamed Fish and Vegetables
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Ingredients
  1. 1 1/2 pounds mild white fish, such as cod, tilapia, or halibut
  2. Zest of 1 lemon
  3. 1 scallion, chopped
  4. 2 garlic cloves, minced
  5. 6 cherry or grape tomatoes, halved
  6. Juice of 1 lemon
  7. 1/4 teaspoon salt
  8. 1/4 teaspoon freshly ground black pepper
  9. 1/4 cup chopped fresh parsley
Instructions
  1. Preheat the oven to 375°F. Line a baking sheet with parchment paper. Fold the parchment paper in half, then open it back up and place the fish on one half, close to the crease.
  2. Combine the remaining ingredients and place on top of and around the fish.
  3. Fold the other half of the parchment over the top of the fish and vegetables. Working around the edges, fold the parchment over tightly in 1/4-inch folds, then fold up the ends to make a closed packet. Bake for 12 to 15 minutes. Remove from the oven.
  4. Place on a plate and carefully remove the fish from the paper and serve.
Adapted from The Meals to Heal Cookbook
Adapted from The Meals to Heal Cookbook
Sand & Succotash http://www.sandandsuccotash.com/

Book Information:

Disclosure: Excerpt from The Meals to Heal Cookbook: 150 Easy, Nutritionally Balanced Recipes to Nourish You During Your Fight with Cancer by Susan Bratton and Jessica Iannotta. Copyright © 2016. Available from Da Capo Press, an imprint of Perseus Books, a division of PBG Publishing, LLC, a subsidiary of Hachette Book Group, Inc. This book was provided by the publisher and any opinions are my own. Any affiliate links help support this site. Thanks.

Neupogen or Zarxio: Strengthening Your Immune System and Tips for Self Injection

If you are about to go on a strong chemo path, or a dose-dense treatment like I was on, your oncologist may prescribe you a series of injections you do at home to help build your white blood cell count and help prevent neutropenia. I took two of these drugs, not at the same time, and this is my experience. Hopefully, by reading this the thought of giving yourself injections will be a little less scary. By the end of reading this, you’ll have a better idea of what you are injecting, how to store the prefilled syringes, and tips for injecting them.

What is Filgrastrim?

First of all, what is Zarxio or NEUPOGEN? These are products made of filgrastim. Filgrastim via our friends at Wiki:

Filgrastim is a granulocyte colony-stimulating factor (G-CSF) analog used to stimulate the proliferation and differentiation of granulocytes; it is a pharmaceutical analog of naturally occurring G-CSF. It is produced by recombinant DNA technology. The gene for human granulocyte colony-stimulating factor is inserted into the genetic material of Escherichia coli. The G-CSF then produced by E. coli is different from G-CSF naturally made in humans.

Filgrastim is used to treat neutropenia, stimulating the bone marrow to increase production of neutrophils. Causes of neutropenia include chemotherapy and bone marrow transplantation.

Filgrastim is also used to increase the number of hematopoietic stem cells in the blood before collection by leukapheresis for use in hematopoietic stem cell transplantation.

A number of companies make filgrastim. The first lisensee to make filgrastim was Amgen, who still makes it under the Neupogen name. Sandoz (Novartis) began making a bio-similar drug, filgrastim-sndz, March 1, 2015, under the name Zarxio. Bio-similar drugs are not generics. I took both of these drugs during my treatment, first Neupogen, then my doctor switched me to Zarxio halfway through treatment.

Neupogen

Zarxio

Injectable Medications: Think About the Good They Do Before You Think About the Needle

As soon as my oncologist said I would need this injectable drug (using needles!), my heart sank. I hate needles. Like, hate them. Not only would I be going through chemo and dealing with all the side effects of that, but I would also be injecting myself (with a needle!) daily for a week, after each chemotherapy treatment. 8 rounds of chemo x 7 injections = 56. I would be stabbing myself (with a needle!) 56 times in the belly. Did I mention I hate needles? That’s why I avoid going to the nurse and getting my yearly flu shot. Sorry, doc.

So, how did I get over my extreme aversion and do it? Because I had no choice. I have three kids at home who could not function without me, and I had no desire to spend time in the hospital because of neutropenic fever. I took a ‘look good feel better‘ class and met a woman who had just recently got out of the hospital from neutropenic fever. I actually looked forward to the injections after talking with her.

I just dived in and did the injections. Gritted (not grinned) and beared it. And while I rejoiced when I did the last injection, honestly, they weren’t really half as bad as I was gearing myself up for as soon as I started.

How to Store Neupogen or Zarxio

These drugs come in prefilled syringes, which I was prescribed. Store these drugs in your refrigerator and bring them to room temperature before injecting. I live an hour away from my chemo treatments and my oncologist, so each time I was prescribed these, my pharmacist would give me a disposable ice bag to keep these cold until I got home. Kaiser is nice like that.

Filgrastim Medication Injection Tips

Injecting a needle anywhere in your body does hurt. But it’s not life ending. I think it hurts more when you inject yourself with something because you are seeing the needle poke your skin. You will be injecting these subcutaneously, in the outer area of your upper arms, abdomen, thighs, or upper outer areas of the buttock. Your dosage will be based on your doctor’s prescription, but I was prescribed each dose for 7 days. And when to take it will depend on the drug itself. For Neupogen, the prescription said ‘daily for 7 days starting 24 hours after completion of chemotherapy’ and with Zarxio the prescription said ‘subcutaneously daily as directed on days 3 though 9 of cycle.’

Since these are stored in the refrigerator, they will need to be pulled out about 30 minutes before each injection. They can stay out a maximum of 24 hours but need to be discarded if left out for more than 24 hours. And note the time when you inject yourself with the first dose – they should be injected around the same time each day. Read each label for exact instructions for the drug you are taking.

Wash your hands before each injection. Swab your injection site with an alcohol swab. Your pharmacy should have boxes of these for sale really cheap. One of the oncology nurses who installed my picc line gave me a big box for the picc line flushings, and I also used these for the Neupogen and Zarxio injections.

Subcutaneous Injection Sites: Courtesy Neupogen Patient Information Literature

Subcutaneous Injection Sites: Courtesy NEUPOGEN Patient Information Literature

My oncologist suggested me do the injections in my belly area, away from belly button and slightly below or left or right of the belly button. I don’t have a lot of fat in that area so I just squeezed a portion of my belly with my left hand and injected with my right. I switched from the left to the right side to help ease any discomfort by always injecting the same spot, but by the time I had 5 rounds behind me, I discovered my right side was so much more sensitive to the needle (as in I felt each injection and it hurt like a bitch) so I just kept sticking my left side, just in a different spot. After 7 injections (or 7 days in a row after each round of chemo), it did get a little sore but the actual injecting went so much better, and I had no bruising from the injections so it was fine. Your body will tell you where best to inject it.

Squeezing Skin Before Injection: Courtesy Zarxio Patient Information Literature

Squeezing Skin Before Injection: Courtesy Zarxio Patient Information Literature

When it is time to inject yourself, simply remove the cap from the prefilled syringe, insert the needle at a 90 degree or 45 degree angle and inject. For me, it went better if I did it slightly at an angle.

After injecting, make each needle safe to dispose of by covering the needle safely. Each syringe will be different, but with both the Neupogen and Zarxio there were built in guards that made this easy. With prefilled Neupogen, there was an orange needle guard that I slid into place protecting the needle after I injected myself. With the prefilled Zarxio, after each injection there was a spring mechanism that activated and hid the needle.

I’ll end this with saying that if you are getting ready to psyche yourself up for your first injection, don’t worry about it too much. Just know that these injections will probably end up saving your life. A little discomfort I guess is to be expected for that honor. 🙂 After all, if you are doing chemo, this stuff’s a walk in the park. Good luck, friend.