Correct Chemotherapy Dosage When Overweight or Obese

As a plus size woman who has struggled my entire life with weight issues, I have been reading with interest the research of Dr. Jennifer Griggs who is an Oncologist and Director of Breast Cancer Survivorship Program at the University of Michigan where I receive my care for breast cancer.  In October, 2013 her ongoing research and the research of others made international news.

Dr. Griggs has studied the topic of whether overweight and obese patients are getting the correct chemo dosages according to their BMI (body mass index) since 2005.  Very often patients are not getting appropriate dosages as this news story from CBS news outlines:

http://www.cbsnews.com/8301-204_162-57603715/

As a patient at the University of Michigan, I always knew I was getting a chemotherapy dosage based upon my weight.  There was a big ritual that was gone through every time I received chemotherapy.  I was weighed not once but twice on two different scales (every overweight patient’s nightmare), a little bit of a panic by your nurse if you lost 5 pounds, calculation by Oncology Nurse Practitioner of your chemo dosage according to current body weight and communication to the Pharmacy, and a rechecking of dosage by two RNs before the dosage was administered.  They calculated my individual dosage according to BMI, had their computer calculators out, checked, double checked and rechecked, and they did it out loud so I could hear it,  showed me the calculations and asked if I had any questions.

But apparently, according to Dr. Griggs’ research, this is not standard procedure every where in the world.  Often overweight and obese patients are shorted chemo dosages.    It makes logical sense that someone who weighs 250 pounds should get more chemo than someone who weighs 125 pounds.  However, giving the correct dosage according to weight can be problematic for overweight patient due to increased side effects.    Since I had a heart attack during Adriamycin Chemotherapy, my heart was at greater risk because of the higher dosage of drugs I received.  On the positive side, however, studies show that heavier patients are less likely to develop dangerous, low blood counts from cancer treatment, and that they clear chemo drugs more quickly from the body than thinner people do.

No matter what weight you are, make sure you ask your Oncologist the question about how your Chemotherapy dosage is calculated and what is the right dosage for you.  IF YOU DO NOT GET ANSWERS that feel right to you, seek a new Oncologist immediately.  Your life depends on it!______________________

Please check out my online store for new items – like cute winter hats!  www.hellocourage.com

Adriamycin and the heart…

Adriamycin (Doxorubicin) does cause heart attacks and heart failure.   I had a heart attack while going through Adriamycin as the heart damage is evident on all my heart tests and confirmed by three Cardiologists.  The vast majority of emails I get from readers of my blog have to do with Adriamycin Cytoxan Chemotherapy known as the “Red Devil”.    There doesn’t seem to be any rhyme nor reason on why some women have very few side effects, and others have debilitating side effects.  Now I have to give you more bad news to watch for serious heart side effects and not overlook them.

I had symptoms of a heart attack during Adriamycin, but thought it was side effects.  Clearly, I remember the night with shoulder pain, chest pain, and sweating. From then on walking up my steps, I had to rest every other step I was so out of breath.  Immediately, I developed a serious cough and even more fatigue.  You might ask, “Why didn’t you do something?”    Well, in my case the side effects of AC were so bad this seemed normal to me.   I never even mentioned this to my Oncologist as being out of breath is normal on AC.   My heart rate also elevated to 112 beats per minute which also can be normal during AC.

AdFinal2

Thank God my Oncologist sent me to the Cardiologist when my Echocardiogram came back with “scary bad results” to quote my Oncologist.   We all blamed it all on Herceptin, but looking back, the symptoms were during Adriamycin.  Herceptin just added to the damage.  The Cardiologist immediately put me on heart meds.  After 10 months of heart meds, my heart has greatly improved I am thrilled to report. 

MD Anderson, the #1 cancer hospital in the USA, recently completed a study about heart failure and Doxorubicin (Adriamycin) with some amazing findings discovering the molecular basis for Doxorubicin’s damage to the heart.  It explains why some people can have a very small dosage of the drug and still get heart damage, yet others who have large doses have no heart trouble:

“Even in this age of targeted therapies, doxorubicin remains an effective agent used mainly in combination with other drugs against a variety of malignancies, including breast, lung, ovarian and bladder cancers,  as well as leukemia and lymphoma,” said Edward T.H. Yeh, M.D., professor and chair of MD Anderson’s Department of Cardiology and senior author of the study.

“However, its use is limited by its cardiotoxicity, which can lead to heart failure,” Yeh said. “We’re excited because we’ve identified the molecular basis for doxorubicin’s damage to the heart.”

The full article can be found here:   http://www.mdanderson.org/newsroom/news-releases/2012/key-discovered-to-how-chemotherapy-drug-causes-heart-failure.html

Because of their findings, MD Anderson is undertaking yet another study to determine if a simple blood test could tell a patient’s risk for cardiac toxicity during Doxorubicin (Adriamycin).   I find that to be absolutely incredible!

But as we wait for that to occur, if you are currently on Adriamycin, watch for these severe heart problems and let your Oncologist know immediately.  Do not hesitate to use that word “heart” when talking to your Oncologist.   If you have taken Adriamycin in the past, pay close attention to your heart.  After my experiences, I would recommend that you see a Cardiologist so your heart can be monitored.  Heart failure can happen many years after taking Adriamycin.

Has all of this been worth it?  Yes, I am still feeling better each day.  That is worth so much.  Do not get discouraged.  It is all overwhelming, but pay attention and speak up!

Protecting Your Heart during and after Breast Cancer

My Oncologist forced me to see a Cardiologist when he discovered Adriamycin Cytoxan (Doxorubicin) Chemotherapy and Herceptin damaged my heart.  I am so thankful he did because I have learned so much that could have gone unnoticed.

A group of Cardiologists at the University of Michigan said Nuclear Stress Tests results showed that  I suffered heart attack during Chemo and Herceptin.    I did have heart attack symptoms like arm pain, chest pain, and breathing difficulties, but thought they were chemo symptoms because chemo will cause these symptoms as well.

There are many new studies out in 2012-13 on the dangers of Chemo and/or Herceptin and severe heart damage.   These studies warn cancer survivors to look for heart problems for up to 5 or more years after you are finished with the drugs.     In most people Adriamycin Cytoxan AC Chemo (Doxorubicin) increases cholesterol, while it is more rare during Taxol.  M D Anderson, the top cancer hospital in the USA, just released some findings on why this Chemo drug causes heart failure:   http://www.mdanderson.org/newsroom/news-releases/2012/key-discovered-to-how-chemotherapy-drug-causes-heart-failure.html

Before Chemotherapy, the protocol is to have a MUGA scan or ECHO cardiogram of the heart.  Then your Oncologist monitors it every 3 months until treatment ends to make sure your Ejection Fraction (EF) does not go dangerously low.  Mine went dangerously low – it fell from 65 to 39 and has remained at 39.   This Cleveland Clinic website gives great information about EF, what is normal and what isn’t:    http://my.clevelandclinic.org/heart/disorders/heartfailure/ejectionfraction.aspx

If you are  prescribed anti-hormonal drugs such as Arimidex or other Aromatase Inhibitors  post treatment, these drugs can also raise your cholesterol.  Tamoxifen can raise or lower cholesterol depending on the person.   Normally, your Oncologist is not interested in your cholesterol levels, but your estrogen levels while on these medications.   Thankfully, my Cardiologist stays on top of this.

Chemotherapy raised my cholesterol.   It raised 36 points after Chemo even though it was normal previous to Chemo.  My Oncologist immediately placed me on a low dosage of Lipitor.  Within 2 months, my cholesterol dropped from 225 to 154 and LDL from 150 to 61.

Oncologists do not check your heart after Chemo is over.  Their job is to keep the cancer away, not be concerned about your heart.  Your General Practitioner may not be aware of the heart dangers after Chemo and Herceptin.   But you need to be concerned about your heart and take actions to protect it no matter what your age.

My recommendations:

1)   Ask your General Practitioner to monitor your heart closely after Chemo is finished.  If they are not already aware, educate them or ask them to research Chemo drugs and the heart.  Ask them to prescribe periodic cholesterol blood tests, liver tests, and additional ECHO or MUGA scans.  Check with your insurance company to see how often they will pay for this.

2)  If you have not had a Nuclear Stress Test, talk to your General Practitioner about this for their recommendations.

3)  Keep on top of this for the 5 years or more after Chemo as you are at a much higher risk than you were previously.  If symptoms show up, immediately get a referral to a Cardiologist.  They are your best line of defense!

4)  If you have any heart-related symptoms, get to your doctor or emergency room immediately.

It is doubtful I would have kept on top of the heart issues had I not been forced to do so.

I don’t want you to make that mistake.