There really is no joy in being a cancer research scientist and undergoing chemotherapy. I have become the ultimate bioreactor, complete with incubator and biological waste disposal mechanism. And I hate it.
My eyes flew open at 1:10am last Thursday morning, with the sound of Prince singing in my head “This is what it feels like…when cells die”….. Based on the last three cycles of chemo, I knew it was coming, I was ever-the-optimist hoping it wouldn’t, but I could almost set my watch to it. I wasn’t really in pain, I wasn’t really nauseous; finding the words to describe how I felt is incredibly difficult. The word that comes nearest is “electrified”, inside and out, in an uncomfortable skin-crawling sort of way. Although the pharmacokinetics are such that the chemotherapy drugs infused on Monday afternoon would have been excreted by the early hours of Thursday morning, they would have by then been converted via my liver and other cells into their toxic metabolites and hit all the cells rapidly going through S-phase, or DNA synthesis, such that those cells were now undergoing a synchronised cell death, destruction and removal. I just know that how I felt is the consequence of those cells dying, along with the body’s immune system kicking into gear, generating a mini-cytokine storm, to rapidly remove the flotsam and jetsam of millions of cells dying at once. No wonder I felt electrified!
Knowing what was happening to the DNA of those happily dividing healthy cells is horrifying. I am on the CMF regimen: cyclophosphamide, methotrexate and 5 fluorouracil (5-FU). Cyclophosphamide is a nitrogen mustard alkylating agent, and methotrexate and 5-FU are antimetabolites. In lay terms they work by cross-linking the DNA or interfering with DNA synthesis, such that the replication of the dividing cells is completely screwed up and the cells are forced to die. Chemotherapy works on the premise that cancer cells are rapidly dividing and therefore highly susceptible to being killed by these types of reagents; it’s just a bummer that skin cells, cells that line the mouth and intestine and hair are also rapidly dividing cells and therefore get caught on the frontline as collateral damage. I try not to think about cancer stem cells and how we know that it is extremely unlikely that they will be cycling, and therefore these drugs are useless against them. Hopefully any cancer stem cells I had will have been removed during surgery and this adjuvant chemotherapy is simply to mop up any recalcitrant breast cancer cells that decided to take a look around my body prior to surgery.
Don’t get me wrong, I am eternally grateful that these drugs exist and have been used for many, many years to treat and cure cancer. It was actually watching children 33 years ago having new drugs tried on them in a last-ditch effort to save their lives, that inspired me to want to work on finding new drugs and better ways to treat cancer, hence turning me into the scientist I am today. After years of working with these types of drugs in the lab, growing cell cultures and working in the oncogene, stem cell, immunology, molecular and cell biology fields, I have a fairly solid understanding of how cells and the body work. I cannot suddenly switch from being a scientist to being a patient, and it is really messing with my head. I feel like I am the ultimate test tube, where the temperature, carbon-dioxide levels and humidity are just right. The oxygen supply, nutrient requirements and waste removal system are all sorted, and now we just let it rip. Things will reach their crescendo of death and destruction, and hopefully there’ll be enough life and energy left for the resting, unaffected cells to heed the call of healing and replenishment and replace those cells that have been obliterated.
So, the electrified feeling lasted throughout most of Thursday, but just as quickly as it came on, subsided by Thursday evening. Unfortunately the dizziness, the feeling of heat and being completely useless for anything, lingered on. Friday and Saturday were filled with an overwhelming sense of fatigue, head-fuzziness and weakness, such that it was an effort to breathe. I also so desperately wanted to rip my scalp off as it itched and hurt. Amazingly I haven’t lost my hair yet; it is thinning and might still all come out as there is definitely something going on in there! Along with that was the joy of an irritated bladder, no doubt a result of acrolein (a breakdown product of cyclophosphamide) damaging and irritating the bladder epithelium (such a pleasant thought). By Saturday night I was so over myself, and despairing of being able to do this again another two times. Each time it has got a little worse and the fatigue more overwhelming. But today is Sunday and we’re turning the corner. I still feel like crap, but I’m not quite as weak and dizzy as yesterday and can actually converse with the kids and walk more than a few steps without feeling like I’m going to keel over. Although my skin feels like it has aged 10 years in the past few days, my face has the look and feel of having had a chemical-peel facial, all shiny and new. It’s a pity the ulcers on the inside also feel shiny and new. I’m kicking myself for not taking ‘before’, ‘sequential’ and ‘after’ telomere length measurements of my blood cells. Telomeres are the non-functional bit of DNA found at the ends of our chromosomes and how long they are provides amazing biological marker information as to our health, stress, disease and ageing. Actually, maybe I don’t want to know how this whole process is ageing and stressing my body, but I do live in hope that I’ll be able to find ways to reverse the telomere shortening when this is all over.
Yay for slow growing cells and stem cells and aldehyde dehydrogenase that prevent total annihilation of the body. The process of healing and repair can now do what it does best. I’m trying to help it by providing the protein, vitamin D, C, iron, chia seeds, green stuff, good oils, natural anti-inflammatory foods, antioxidants…..anything I can do to get this bioreactor back into balance. But most of all I’m trying to learn the art of mindfulness, stillness and meditation, so I don’t have a complete mental breakdown thinking about the physiological processes going on inside. “Breathing” has become my touchstone and best friend when the crazy scientist in my head gets out of control. I do also know from the books and research I have read in recent months that there is a profound physiological connect between our mind and body, and true healing will only come when these things are aligned. The scientist in me is working on this challenge of true healing. I really wish I’d taken those “before” measurements……..