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Dr. Terpenning recalls the most common side effects associated with chemotherapy.

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Common Side Effects of Chemotherapy What Are Some Common Side Effects Associated With Chemotherapy? Dr. Marilou Terpenning: Chemotherapy can have a number of side effects. The most common side effects that aren’t well thought about are fatigue, which happens almost universally. Most people on chemotherapy will have some fatigue for a few days afterwards and then, gradually throughout the course of treatment for their breast cancer, will have a progressive fatigue till they function around two-thirds of their normal capacity by the time they are done with their chemotherapy. Another side effect that people are very afraid of is nausea, vomiting, and many people have memories of family members or friends who have been through chemotherapy in the past, and they need to make sure they understand what their program is going to prevent them from having that. The good news is we have tremendous variety of new drugs that are used that are adjunctive medications. Adjunctive medications mean medications that we give to mitigate and prevent side effects from chemotherapy. So, we have excellent oral and intravenous anti-nausea medications that are given before and following chemotherapy so that that side effect is quite minimal now. There are some women who are very sensitive still, and their program can be modified, so you shouldn’t feel as if you somehow failed if you have nausea just by taking all these medications, but nonetheless, we can do a really good job for you. Another side effect that most women are very afraid of is hair loss, and hair loss is perhaps the most delicate subject that we talk about. It brings tears to many people’s eyes or stoicism to the other peoples’ eyes. It’s a hard thought to think about losing your hair, and I think it’s important to know when to expect it and what you can do about it and how it’s going to feel, what you might be going through. So, what I usually tell my patients is that for most chemotherapy drugs, the hair loss occurs anywhere from 17 to 19 days after their first treatment, so they can count on that. One of the most important things we do, when we anticipate hair loss, is to make sure that someone has a referral to a range of cost suppliers of hair prostheses, i.e. wigs, and write a prescription for that so they can go shopping. Also, give material on how to use scarves and hats because not everyone wants to wear a hair piece, and the interest ranges from having a human hair replacement, which can be quite pricey, to having a fun platinum blonde wig. It just depends upon the mood. The time that’s the hardest is when you are actually having the hair come out, and I warn people about that. No matter how much someone educates you, it’s hard to prepare for the feeling of what it feels like to have your hair coming out in clumps. I recommend to my patients that they might try cutting their hair shorter before they lose their hair so they can get a hairpiece that’s easier to match, but that depends upon the woman. Some women want to keep their hair long and will get a long hairpiece to replace it. I usually recommend that they have someone lined up like their husband, boyfriend, hairdresser, to shave their head when the hair starts coming out because it’s very sad to have it come out in pieces. If they don’t want to have their head shaved, I recommend they sleep in a hair net and use satin pillowcases, but in the shower it will come out. So in general, it’s a painful moment, and it’s usually over and done with if a woman shaves, but not every woman is able to do that. It really depends upon the person, so you need to get to know yourself if you feel comfortable with that or not. You may not even decide that until it starts coming out because some people just put that thought aside until it starts coming out, hoping that they will be the one in a thousand that don’t lose their hair, which is a good thought. Then after the hair is out, which is the sad moment, it takes a day or two to recover or to adjust to it. You don’t ever really fully accept it, but the painful part is usually the first day or two afterwards. So, that’s why it’s good to have a hairpiece there and plans in place as to how you are going to take care of yourself and make yourself look good. Some of my patients never get a hairpiece; they put tattoos on their scalp and wear big gold dangling earrings, and it’s wonderful. They celebrate their alopecia, which is the medical term for baldness or hair loss. Some other women are very uncomfortable, and no one ever knows, including their husband, that they have lost their hair because they never let anyone see them without their hairpiece. The real secret is there’s absolutely no right or wrong. It’s most important to do what makes you feel good about yourself because you are the queen of the day. You are the center show, and you really should do what you want to do to make yourself feel good about your body while you are going through chemotherapy. Your hair will come back, which is hard to believe. It comes back in curly. It usually starts coming back in maybe a few months after you finish your chemotherapy; within a month you’ll have fuzz. By two months, you have a little bit of hair. By four to five months you’ll have a really cute cap that if you are bold enough, you can wear without a wig. It depends upon the person how curly it is. It often will come back in a different color. My happiest patient is a 75-year-old woman came in platinum blonde, but I don’t give out warranties on that because it only happened to one woman in 35 years. And so, most of my patients come in, if they were blonde they will come in a darker blonde, sometimes with some dark brown to it. It may come in gray-black. It may come in steel gray, and it may come in white even. But again, it usually comes in wavy, and most people are happy if they’ve had straight hair like me all their life because it’s kind of cool to have curly hair in the middle of your life. So, it’s a new adventure. So, when I talk to women about this, I try to help them understand the process and get them together. One of my patients did a really great video when she lost her hair and her shaving and her party afterwards, etcetera, so I share that sometimes with other patients. We have a video viewing room in the office. Other side effects of chemotherapy, to get back to the main topic, can include lowering of the blood counts. This is a silent problem. You wouldn’t know a thing about it. The bone marrow is a really busy place in our body like our hair follicles. So, like the hair follicles, bone marrow is affected by chemotherapy, and bone marrow is inside your bones. You’ve all seen it when you’ve looked at a piece of steak and seen at the steak bone with a marrow in the middle. That’s where all your blood cells are made, the red blood cells that prevent anemia, the white blood cells that fight infection, and the platelets, which are the sticky things that stop you from bleeding, and chemotherapy can lower the production of one or any of those different blood elements. That’s why it’s important between chemo treatments to come to the office to get a blood count check to make sure that your bone marrow is holding up well to chemotherapy. If it’s having any problems, you can get boosting drugs to help get it protected so that you don’t have a low white blood count, for example, and aren’t at increased risk for infection. Chemotherapy has other sundry side effects depending upon the drug. For some drugs, peripheral neuropathy can be a side effect, numbness and tingling in your fingertips and toes. For some chemotherapy, nail changes can occur. For some chemotherapy, there can be a risk of weakening the heart muscle. For some chemotherapy, you may get some aches and achiness and stiffness afterwards. So, the specifics of each individual drug you’d have to go through with your doctor, but the general side effects are the ones that I have mentioned; fatigue, possibly nausea and vomiting, hair loss likely with most chemotherapy regimens and affecting the bone marrow, dropping your blood counts and possibly putting you at risk for infection.