The Scary Chemotherapy Side Effects – FEC and TCHP

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Nothing you´ve heard about chemotherapy is comparable with living the experience yourself. I had aunts who had chemo, but I never got the chance to go with them to any of their sessions, and I was never with them on the days right after receiving their chemo infusions, so my only knowledge of chemotherapy was from what I had seen in movies: the vomiting right after, the extreme tiredness, and the hair falling in big bunches, leaving the patient in huge distress. This patient would be a woman (to make it more traumatic, as women usually have longer hair), who would immediately shave it and cry, and be miserable.

Well, it isn´t necessary to say that some things are always exaggerated in movies, but many things that occur after receiving chemo you have never seen them in movies or even heard about them: your can get really weird stuff in your body after receiving such strong treatment. But the good news is that there is a solution for every single side effect you might get.

There are different types of chemo drugs out there, and every person is different, so this is something that you really need to bear in mind. You might not get as many side effects as the specific drug can cause you, but you could have every single one of them as well, and even things that aren´t listed in the information leaflet. Besides that, you can have a side effect after one cycle, but you might not get it during your next infusion, so you really won´t know what´s going to happen until it actually happens. It´s so much fun…

You can wait and see how you react to your first chemo to see what specific side effects you might have, and ask the doctor for medicines to avoid them in your next cycle. Of course, if these side effects are unbearable, call the hospital immediately and get a prescription to fix it, but you will still need to bear with those nasty effects for a few days until the problem is sorted.

Sometimes, however, it is better to prevent them, so keep reading to see how can you avoid some of the most annoying ones! Here you are a few tricks!

Nausea/Vomiting

Nowadays they give you so many pills for the five days that follow Chemo (and sometimes even from the day before) that it is rare you end up vomiting. But, if you find yourself throwing up, then tell your doctor to fix your medication immediately, because you should not be experiencing this.

It is important that the medicine they give you for the side effects of chemo works well for you, because that is the whole point of receiving those strong drugs (that usually have other side effects on their own), so tell your oncologist absolutely everything that has happened to you after the previous cycle. Do not leave anything out!

Still with all those pills that your oncologist will prescribe you to avoid vomiting, you will feel as if you have eaten a whole cow, after just drinking a bit of water. Some people find it really hard to eat and drink during these days, so forget about being healthy at this difficult time, and just eat what your body can accept. A good advice I received is: “Eat small portions more frequently.”

However, do not misunderstand this piece of advice. We all have heard that some Cancer patients lose lots of weight during their treatments and that sometimes, people die because of malnutrition rather than from the Cancer itself. Then, as a patient, you get scared with this information and you start stuffing your face during the chemo months with sweets and other high-calorie foods you can find. Well… do not do so!

It is true that some Cancer patients (especially the elderly and also patients with an advanced stage of Cancer) can really struggle to eat during chemo and they indeed die because of malnutrition. However, if you are not that old and your Cancer isn´t spread everywhere then forget about that fact. During your chemo the oncologists will prescribe you steroids and you will probably put on some weight during these months. The steroids are given because some chemo drugs are really strong on your stomach, and it is the only way your body can receive them (like it occurs with Taxotere/Docetaxel).

For example, in breast cancer, almost all patients gain weight during their chemo, so do not eat just for the sake of eating, as many patients do (I have done it!) You won´t die if the days after your chemo you cannot eat much. Don´t worry.

Drinking ginger and mint teas can help you a lot with the nausea during these days, and always, always, always, drink plenty of water! You want to flush those chemo drugs out of your system as soon as possible, so keep a big bottle of water next to you at all times.

Please, note: if you are very slim, it is true that you won´t need to worry while receiving Taxotere/Docetaxel, as you will always gain weight thanks to the steroids that they will prescribe you, but with the FEC/AC chemo combo you might lose some weight. At least I did lose about 2 kg, even though I manage to eat a lot during those moths. If this is the case for you (you are a slim person and you are going to receive FEC/AC) remember the rule of eating small portions of nutritious food throughout the day. Eat bananas, yoghurts, nuts, honey, avocados, fish, soups, lentils, ice-creams… and you won´t have any problem.

Constipation

The medicines that will help you avoid nausea will unfortunately cause you constipation. It is important that you go to the toilet regularly during this very first week, though, because some of the drugs you will receive are mainly expelled through your excrements (not a very nice talk, I know, but a necessary one).

In order to avoid constipation, keep on drinking lots of water during the week, and try to eat everyday yoghurt or kefir with prunes, figs, dry apricots, raisins, berries, kiwis, nuts, chia and flaxseeds, honey… anything that contains fibre and helps you go to the toilet. If you need extra help, do not be shy and ask your oncologist to prescribe you something.

From time to time I used some natural pills called Aliviolas, composed of Dandelion and Aloe Vera. These ones are Spanish and work very well, but you can always get natural pills for this purpose in any herbalist shop.

Mucositis

Mucositis is when your mouth becomes sore and inflamed. It’s a very common side effect of chemotherapy and radiotherapy. I noticed that many chemo patients believe they have a cold during treatments. It is understandable; this happened to me, and after receiving my first chemotherapy cycle I thought I had a sore throat. But it is the chemo. It´s always the chemo.

In order to avoid this, just drink as much water and liquids, especially herbal teas, as you possibly can. Natural fruits and vegetables juices will replenish your body with nutrients that will definitely help make this period easier for you.

Mouth Ulcers

Mucositis can cause really bad mouth ulcers. Many people swear that if you suck on ice lollies or ice cubes while receiving your chemo you will avoid mouth ulcers. I have tried that, but it didn´t work for me.  It might be because I didn´t do it right, but I found it really annoying to have to put massive ice cubes in my mouth in those London winter months.

What did work like a charm was to use the mouthwash prescribed by my oncologist three times per day (morning, midday and night), after carefully brushing my teeth with a very soft brush and natural toothpaste, free of chemicals (you can find these in Planet Organic or Whole Foods). The toothpaste I used was this one, free of fluoride:

https://www.planetorganic.com/aloedent-sensitive-100ml-100ml/6042/

Fluoride can be found in almost all toothpastes, and it is even added to tap water! It prevents tooth decay and that is why it is added to tap water in many countries, but it can be irritating, and if you are receiving chemotherapy it can hurt your mouth. A lot.

If you live in America, check these nine organic brands:

https://www.allure.com/gallery/best-natural-organic-toothpaste

The mouthwash prescribed by my oncologist was Benzydamine, which is an anti-inflammatory and painkilling medicine. It reduces mouth and sore throat pain. It also desinfects the mouth and throat, helping you keep it clean during this difficult time in which your white cell count will go very low.

You need to start doing this on the very same day that you receive your chemo infusion, and continue with the thorough-but-soft brushing for two weeks. Only during the third week after your chemo you can relax and brush your teeth normally.

As I´ve always preferred natural things, I did try the typical and natural mouthwash (made of mineral water, salt, peroxide water and sodium bicarbonate) twice per day, but this did not work as well as the Benzydamine. Unfortunately, with such strong drugs as chemo drugs are, you also need strong drugs to alleviate its side effects.

The chemo combo FEC (Fluorouracil/Epirubicin/Cyclophosphamide) would not provoke mouth ulcers (for me, only one small one after my third infusion), but Docetaxel/Taxotere was an absolute killer, causing me seven ulcers if I didn´t use the mentioned mouthwash three times per day.

Do this religiously and you won´t encounter this uncomfortable situation. If you still get ulcers or a sore mouth, then keep on using the mouthwash, which will numb the area, but you can also try to apply Alum powder onto the ulcer: put a little pinch of it, and leave it for a minute. Then, rinse well with water. The feeling in the area will be very weird; try not to touch it with your tongue or swallow it!

I bought mine on Ebay and it worked quite well in speeding the healing of the ulcer.

Remember that your white cells will decrease considerably, so any bacteria will cause you harm, especially a week after receiving your infusion.

Again, drink plenty of water and chew sugar-free gums to keep your mouth moist.

If you develop mouth ulcers, because you forgot to brush your teeth and use the mouthwash three times per day, then these tips will help you relieve the pain a little:

  • Do not smoke
  • Watch your food

Don´t eat:

-Sharp foods (i.e. crisps)

-Acidic foods (tomato would kill me if I had a sore mouth, and of course, lemons and oranges were killers as well)

-Hot foods (forget about soups or hot teas during this time)

-Spicy foods (if you want to be happy, ignore your favourite spicy sauce for a few days)

Salty foods (I could not eat my super salty sunflower seeds, which I love, for months)

-Alcohol won´t help. I didn´t drink alcohol during the whole duration of my Chemotherapy tretment, but I could not even drink non-alcoholic beers when my mouth was sore. Anyway, why would you drink these beverages if it isn´t going to taste like anything you remember?

Your mouth will only want ice-creams during these days, to be honest with you. If you have a sore mouth, bear with it, but remember to brush your teeth and use the mouthwash three times per day during your next cycle, and you will avoid this uncomfortable side effect!

Burning Pee

This occurred to me shortly after receiving FEC and THP, so I assume it is a general side effect of chemo. But sometimes I wonder if it was just the drug Epirubicin (the Red Evil; the “E” in the FEC combo) the one causing it and destroying my area for months… After you receive Epirubicin, you will soon feel the urge to pee, and it all comes really red. So I wonder if this was the cause of my burning sensation.

Two weeks after receiving you cycle of chemo it will calm down a little bit, but this burning feeling while peeing continue for the whole chemo period, and sometimes even after finishing. It isn´t pretty, I must say.

Again, drink plenty of water, because the more you drink the less pain you will have.

Using a nappy cream and coconut oil in the area will help ease the pain.

Neutropenia

It is a very common side effect of chemotherapy. It means that you have a low number of neutrophils (a type of white blood cell) in your blood. If severe, it significantly increases the risk of infections, which can easily be life-threatening during this time.

It is impossible to avoid neutropenia usually eight days after receiving your chemotherapy shot. The FEC/AC combo is harshest that the TCHP with this side effect. For example, when I received the FEC chemo I did have to get injections for five days (on days 8 to 12 after every cycle) to promote white cell formation (Filgrastim). But when I received THP (Docetaxel/Taxotere) I didn´t get these injections, as in this combo there is less chemo (one chemo drug as opposed to three).

There is nothing you can do to avoid Neutropenia apart from using Filgrastim injections. If you are not given this medicine (I didn´t get it while on THP), eat as many different nutrients as you can to promote white cell formation (remember: eat small portions frequently!) There are no specific foods proven to increase the production of white cells, but it is obvious that nutritious foods will help you better than eating MacDonald’s.

As I said, you will be more susceptible to infections, so you need to practice good hygiene: shower, wash your hands and your teeth regularly, and do not forget to wash well the fruits and vegetables you eat. During these days avoid eating or touching raw meat, eggs and fish, mouldy or expired food, unwashed fruit and vegetables, and unpasteurised drinks.

Perhaps you can try to stay home during these days, but if you have to got out, then avoid small and closed places like the public transport, the office, a plane, etc. Some people use masks during this time, as they don´t want to risk catching an infection and postponing their next chemo infusion. I totally get this. Who would want to postpone a Chemo appointment? The sooner you finish, the sooner you will feel yourself again! I did buy a mask but didn´t get to the point of using it, because I didn´t go out as much during those days.

Please, note that even if you stay at home most of the time, it is really easy to catch an infection even from your family or from your own bacteria! Ask your family to wash their hands when they arrive from outside, and be careful with the kissing! No kidding here. Your white cells are going to be a quarter (if lucky) of what they normally were when you were healthy, so even your own bacteria (from your toothbrush for example) can cause damage to your body, as this cannot defend itself as it used to.

Wash your toothbrush with peroxide water everyday, and keep next to you an antibacterial gel for your hands at all times.

Neuropathy

Neuropathy is a nerve disorder caused by some chemo drugs, and common symptoms of neuropathy include numbness, tingling and pain.

With FEC I only noticed one day (after my 2nd cycle) in which I felt a bit of neuropathy on the same day of chemo (from 12 to 2am, about 6 hours after finishing the infusion). However it is not common to feel neuropathy with FEC.

But it is very common (and expected) to feel neuropathy with THP (or TCHP). The Docetaxel/Taxotere is the drug causing this nasty side effect. But guess what? I completely avoided this by doing a few things (recommended by American and French oncologists, and also by many girls who have had the courage to try these things).

When my oncologist told me that Taxotere would give me neuropathy, and that it could easily last forever (can you imagine? For life!), I spent day and night trying to find out how to avoid it.

It was frustrating, as oncologists know that these side effects will occur, but they don´t investigate at all how to try to avoid them! I mean why would they do that? It isn´t them the ones who can feel neuropathy for life.

I told my oncologist about all the things I was going to do to try to avoid neuropathy and he said: “Why? Don´t do that! You are crazy! It´s not going to work! You are wasting your time!”

Can you believe it? Wasting my time… As if I had any other better thing to do with my time at this moment of my life.

He was very nice, but in that sense he was really stupid (let´s call things by its name). He could be listening to his patients (who listened to many other girls who tried these tricks), and he could be giving good advice to other girls, but he preferred to stick to what he studied in the books. I find it so sad.

If you want to avoid neuropathy, please try these things, because they might work for you, as they did for me. I didn´t come up with them, it is the knowledge of oncologists from other countries and from girls who experimented this on themselves, so if you want to avoid this horrendous side effect, just give these a go! You don´t have anything to lose and much to win.

A month before your THP or TCHP chemo starts (or as soon as you can, really), take these supplements:

L Glutamine

L-glutamine or just glutamine is a non-essential amino acid produced by the body, and that is also found in food.

The body requires twenty essential and non-essential amino acids that work to create proteins. Being able to get adequate protein is critical for everyone, but more important for a Cancer patient receiving chemotherapy.

As soon as I started taking this supplement I felt less tired and I clearly had more muscle because of it (as I was not able to do any exercise during chemotherapy!) However, a month after finishing chemo I stopped taking it, as it isn´t recommended for a Cancer patient. Cancer cells feed themselves with glutamine (also with glucose and fat), and it is just better to stop taking this supplement after finishing with Docetaxel/Taxotere, just in case residual Cancer cells use it to feed themselves and become more aggressive.

Alpha Lipoic Acid

It is a vitamin-like chemical called an antioxidant. Foods such as yeast, liver, kidney, spinach, broccoli and potatoes are good sources of it.

It is commonly taken for nerve-related symptoms of Diabetes and other illnesses, such as pain, and numbness in the legs and arms. High doses of alpha Lipoic Acid are used in some countries for the treatment of these nerve-related symptoms.

Vitamins B1, B2, B6 and B12

Vitamins B are usually given in complex (rather than individually), although they can also be bought individually. All vitamins B (and also C) are water-soluble (they dissolve in water). This means that they are carried through the bloodstream, and when they are not needed they leave the body through the urine. So this means we need to consume vitamins B (and C) every day, because the body can only store small amounts. While receiving Chemotherapy you need to pay especial attention to the following B vitamins.

B1 (Thiamin) is one of eight B vitamins that are essential for human health. It enables the body to use carbohydrates as energy, and it plays a key role in nerve, muscle, and heart function. It prevents inflammation of the nerves and that is why is so important while receiving certain chemotherapy drugs.

The recommended daily amount for adults is1.2 mg for men and 1.1 mg for women.

B2 (Riboflavin) is very important for breaking down food components, absorbing other nutrients, and maintaining tissues. It can be found in eggs, nuts, meats, broccoli and green leafy vegetables, whole grain, bread, cereals, and dairy products.

The recommended daily amount is 1.3 milligrams for men and 1.1 mg for women.

B6 (Pyridoxine) is really important for protein, fat and carbohydrate metabolism, and it promotes the creation of red blood cells and neurotransmitters. It can be found in fish, beef, liver and other organ meats, potatoes and other starchy vegetables, and fruit (but not in citrus).

The tolerable upper limit of vitamin B6 is 100 mg per day for adults.

B12 (Cyanocobalamin) has many essential functions in your body. It’s necessary for keeping your nerves healthy and supporting the production of DNA and red blood cells, as well as maintaining normal brain function. It can be found in eggs, meet, salmon, tuna, trout, but also in non-dairy milks.

The recommended daily intake is about 2.4 mcg.

All these supplements do not interact with the chemotherapy drugs (I asked several oncologists about it) and they will help you massively in avoiding neuropathy caused by chemotherapy. Be faithful to them, and constant in taking them!

Apart from taking these supplements, putting your hands and feet on ice during the Taxotere/Docetaxel infusion will help you avoid Neuropathy. Keep reading to find out how to do this!

Brittle Nails or Nails Falling out

Taxotere is a very strong drug with really strange side effects, and one of them is that it can make your nails fall out. Firstly, it will turn your nails yellow. After that, they could become black and, finally, these could come out completely. My oncologist said this happens to 70% of women receiving the drug, but I think he was just making up the figure. However, it is not uncommon to lose nails in your hands and feet due to this drug.

Is there a way to avoid it? I believe there is! I followed these steps and my nails stayed in place during the whole process:

– Avoid professional manicures and pedicures during these months. They use tools that might not be disinfected and this could create you problems.

– Cut your nails very short every time you are going to receive a cycle of Taxotere, as they will become weaker than usual.

– Paint your nails with Nailtiques Formula 2 or a liquid that strengthens your nails. I mention this specific one because I heard that in America oncologists recommend it to their patients, and I bought it here in the UK (online) for 15 pounds. It lasts forever (I still have a lot, and I finished chemo two months ago) and it has worked so well that I bought one for my mother, and would like to buy one for everyone I know. It really works! You have to paint your nails with one layer of this miraculous liquid. The next day you can put another layer and then, another one, before you paint your nails.

– Paint your nails with a dark colour (on top of the Nailtiques), as Taxotere, apparently, in contact with sunlight might make nails get black and eventually fall out. Keep them dark during the months you are receiving chemo, and for two months after finishing.

– Use gloves while you do house work (dish washing, cleaning, gardening), but avoid doing much work during these months. Get spoilt at home!

– The less you have your nails in water, the better!

I´m not going to recommend you not to wash your hands or even shower, but, during chemo, I was most days at home, and sometimes I would skip a full shower, in order to save my nails, and, no: I am not ashamed to admit it!

While on Taxotere, to have a shower and wash my head would mean to have soap entering my eyes all the time (as there weren´t eyelashes to stop the soap), and I was literally in pain, so it won´t kill you to skip a shower really; it will actually be beneficial, as long as you clean your secret and important parts (keep them clean everyday to avoid infections).

– Avoid wearing tight shoes.

My toenails didn´t fall or even change colour but they grew a little bit differently from usual. It was like if I had ingrown nails all of a sudden.

An ingrown toenail is when the nail curls and pierces the skin, which becomes red, swollen and tender. A delight. Don´t feel tempted to have a professional pedicure, as the tools they might use on you won´t be sterilised. Remember that your immune system is compromised. The only way to survive this period is by using your own tools, and learning how to deal with an ingrown nail if this happens. It might help you if you soak your feet in vinegar and water daily, for about 15 minutes.

Now the most annoying measure to take:

I placed my hands and feet on ice while receiving Taxotere.

It isn´t easy, I´m not going to lie, but it did work for me, as my nails only became a bit yellowish, like when I used to be a smoker (disgusting, I know) but at least they didn´t turn black and fall! This radical measure also helped me avoiding neuropathy from the Taxotere.

uñas chemo

Read this and you will get convinced!

https://www.curetoday.com/articles/frozen-gloves-and-socks-help-reduce-chemotherapyinduced-peripheral-neuropathy-in-patients-with-breast-cancer

Or this!

https://consumer.healthday.com/cancer-information-5/chemotherapy-news-122/cooling-mitts-socks-may-ease-a-major-chemo-side-effect-727609.html

How to Do the Ice During TCHP to Avoid Neuropathy and Nails Falling Out

They do sell specific gloves you can use, but they are so expensive! Something that makes me quite angry, as they are clearly trying to make a business out of our misery. The only frozen gloves (or Cool Mitts) that I could find cost 250 pounds! There is also the Elasto Gel ones, which you can find for 70 pounds on Ebay, or here for 54 pounds:

https://www.physioparts.co.uk/elasto-gel-glove

For shocks, you can find cheaper options at 20 pounds in Amazon:

https://www.amazon.co.uk/gp/product/B003L4WOKG/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

Those are the ones I bought and that worked well for me, as I didn´t develop neuropathy in my feet at all, and my toenails didn´t become even yellowish. They were all perfectly fine for the whole duration of the chemotherapy.

However, if you don´t want to spend money at all, you can use this fantastic method for just 2 pounds!

As I didn´t have any gloves, I decided to buy latex gloves and bags of ice (two bags from Tesco at 1 pound each) every time I received Taxotere.

I placed the gel-shocks in the freezer, and on the day of the chemo I would take them out and put them in a thermo bag, with one bag of ice at the bottom and another on top.

If you don´t get the gel-shocks it is absolutely fine, as you will be ok by using normal shocks with ice. Just remember to bring an extra pair of thin shocks for the day (you will wet them) to protect the skin from burning with the ice.

If your hands are very delicate you might need to put another pair of thin gloves (you can find them very cheap at Decathlon) instead (or on top) of the latex ones. My skin is really delicate but I was OK with just the latex ones. I did put more cold in my hands than in my feet, as I think feet are more resistant to Taxotere.

I also bought this thermal bag in Amazon to bring my ice bags and gel-shocks on the day of the chemo infusion.

https://www.amazon.co.uk/gp/product/B00BQWWI5Q/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

There are several sizes, but I recommend the one for 24 cans, as ideally you will need to fit these two ice bags.

Remember that a chemo day with Taxotere can be as long as 10 hours! And that is why you might need a thermal bag.

How do I do this?

It isn´t comfy or easy; you must know. With help from someone it will be so much easier.

Just open the ice bags from one side (not from the top or from the bottom) and insert your hands (protected with the gloves). Make sure your nails are covered by the ice. It is better when the ice has started melting a little, so the cold water will touch all nails and the palms of your hands very easily.

It is really uncomfortable and a long process, but I promise you it is so worth it! Your hands and feet will be cold and red when you finish, but rub them well with a towel and wear very thick shocks after to go home. This process would be much easier to do in the summer of course. For me it was winter and the hospital was freezing, so I won´t lie: It wasn´t pleasant.

For How Long?

Start 20 minutes before receiving Taxotere/Docetaxel/Taxol. Keep on the good work for the hour the infusion lasts, and continue for 20 minutes after finishing. 1 hour and 40 minutes of suffering, in total, I know. Tough, but you can do it!

Specific Chemo Drugs and Side Effects Day By Day:

FEC (5 Fluorouracil, Epirubicin and Cyclophosphamide), which is similar (only worst) to AC (Adriamycin/Doxorubicin and cyclophosphamide).

Some other girls with Breast Cancer receive AC instead of FEC, which is a similar chemo combination but without the 5 Fluorouracil, which apparently has been demonstrated it doesn´t help much in Breast Cancer, and, instead, this regimen has fewer side effects.

On the other side, Doxorubicin and Epirubicin are both anthracyclines; very efficient in the treatment of Breast Cancer. However, some studies indicate that Epirubicin is slightly harshest in the heart than Doxorubicin.

So, basically, you are luckier if you receive AC instead of FEC.

It is interesting to note that in the UK they give you FEC, while in the USA and other many European countries they give you just AC.

Check the general side effects of FEC here:

https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/fec

Or, alternatively, check my personal diary after receiving FEC:

Day 1 (evening after the chemo infusion) to day 5:

Metallic Taste

Many patients report it from the very first moment they are receiving the chemo. I did feel it, but only during my 2nd cycle, while they were giving me Epirubicin.

Tiredness

Four or five hours after you finished your chemo, you start feeling like if you have run a marathon without any training; being really unfit.

Drowsiness

From that very first evening you feel really hangover, just without having had all the fun (especially if you have done scalp cooling; in such case you might even need help to walk!)

Nausea

You also feel like if you have eaten a lamb after just drinking a bit of water. Take it easy and rememeber to eat little by little.

Sore throat

You really feel like if you did catch a cold, but it is not a cold, it is mucositis. This got worse for me after the 2nd and 3rd cycle.

The medicine usually given in the UK when you receive FEC, in order to avoid Nausea is:

-Domperidone 10 mg tablets, three times per day, for 5 days starting on the evening after Chemo.

-Ondasetron 8 mg tables, twice per day, for 3 days, starting on the evening after Chemo.

-Aprepitant 80 mg tablets, only for two days starting the next day of Chemo.

-Dexamethasone 2mg tables, for 3 days after Chemo.

These medicines helped me avoid nausea wonderfully; but if they don´t go well for you, then, the doctor must prescribe you others. They will also give you all these pills just before having your first infusion, so they can make sure that they are suitable for you. You can take all of them at the same time, in the typical little glass that you have seen in the American movies (when they give medicines to the crazy people, yes).

The problem is that some of these pills (especially, Ondasetron) will make you constipated, so, if you don´t go to the toilet, by day 5 you might experience really bad pains. For me, the 5th day after FEC was the worst; I was really weak and my legs were shaking so much, that I thought I was going to collapse at some point.

Piece of Advice:

From day 1, take as much fibre as you can, and drink not less than two or three litres of water. Before starting my second cycle of chemo, I asked the oncologist for medicines to go to the toilet, because all the fibre in the world did not make me go to the toilet during that 1st cycle.

According to many FEC patients, days 5/6 is when you feel most tired. On day 5 I was in the sofa with the only energy to watch movies. I didn´t even have the energy to change them if they were bad ones.

Something that started happening pretty soon after FEC was a horrendous burning sensation while peeing, that only calmed down a little bit by the third week after each cycle. Drink, drink and drink more water.

Day 8 to 12:

The peak time with FEC is from day 8 to 12. That is when all your defences (white cell count) go so down that you might be able to count them with the fingers of one hand. OK, that is a massive exaggeration, but they will go really low, making you develop neutropenia (an abnormally low number of Neutrophils, a type of white blood cell). The number of white cells will go up eventually, but on these days it is really easy to get infections, so, because FEC is composed of three different chemo drugs, they will give you injections, such as Filgrastim, for 5 days.

Filgrastim consists in one syringe that you need to inject yourself subcutaneously once a day, for five days. I did it in the mornings. You just have to grab the fat tissue of your belly, about 5 cm away from the belly bottom (to the right or left), and quickly insert the needle, and, then, the liquid. They already come from the box ready to be used, so you don´t need any preparation. Please, note that the needle, once inserted, reverse and disappears, so don´t be scared if the needle isn´t there when you pull it out. My mother freaked out once she helped me do this, when she saw that the needle didn´t come out of my belly. It was funny to see her face.

This injection is given to increase the white cell count, and you MUST storage it in your fridge as soon as you arrive home from the hospital. Half an hour before you use it, take it out of the fridge.

On my fourth day of injections after cycle 1, my heaps started hurting, then my knees, and about nine hours after the injection I had the most horrendous pain I have ever experienced in my life. It was in my lower back, and it was not muscular; it was coming from deep inside my body. It turned out to be the bone marrow producing white cells, due to the Filgrastim injections. I would have appreciated the heads up from my oncologist. It happens to almost everyone receiving these injections!

It was an incredible pain, like if a giant hand was grabbing my bone marrow and making juice out of it. I was physically folding myself because of the pain. I couldn´t sit down, or lie down or stay standing; basically I didn´t find an appropriate position, and the pain was getting worse and worse. I took 1 gram of Paracetamol straight away, and called the urgent helpline hoping they came to collect me (I swear it was that bad). It took the Paracetamol a full hour to make its effect, so for the next cycle I asked my oncologist for something stronger, and they gave me Cocodemol (Paracetamol with codeine).

The urgent helpline in the UK was interesting. They didn´t pick up the first time, and when I called again, they told me to go to the pharmacist to get something for the pain. Most useless service ever.

The side effects of cycles 2 and 3 of FEC were pretty similar to the 1st one. The only difference was that I lost all my hair on the first 10 days after my 2nd cycle, so 31 days after starting FEC. Losing the hair deserves, of course, another whole different post in this blog (soon to come!).

I did also get an ulcer after cycle 3 of FEC, and Diarrhea on day 18 after the 3rd cycle, which can occur at any time while on FEC.

TCHP (Docetaxel/Taxotere, Carboplatin, Herceptin/Trastuzumab and Perjeta/Pertuzumab

I received THP, as in the UK they don´t give Carboplatin (don´t ask me why, but I definitely need to ask this at some point), so I will talk about the side effects I had from THP.

The only chemo drug in this combo is Docetaxel/Taxotere. Herceptin and Perjeta are targeted therapies, which are different from chemo drugs.

Targeted therapy drugs don’t work the same way as standard chemo drugs do, because they go after what makes the Cancer cells different from the normal ones, while leaving most healthy cells alone. That is why targeted therapies have fewer side effects. Please, note that they still might have some serious side effects. For example, Herceptin can seriously damage your heart, and that is why you will frequently have heart ultrasounds while on Herceptin, to make sure this drug is not hurting you.

For an exhaustive list of side effects of Taxotere check this link:

https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/going-through-treatment-breast-cancer/chemotherapy/docetaxel-taxotere

For my personal diary, keep reading.

Day 0 (day before the chemo infusion) to day 3:

Docetaxel (Taxotere) is so strong in your stomach that you need to take steroids (Dexamethasone) from the day before your chemo infusion, and continue on the day and the day after (3 days in total), to avoid vomiting. Steroids will make you be a bit swollen and bloated. I actually did lose weight while on FEC (2 kg), but I did put on 2.5 kg while on THP.

The infusion of THP is so much longer that FEC, because they have to give it to you slowly and observe you for a while after that. That is how strong is Taxotere, that it can cause serious damage to your heart or give you an allergic reaction after. On the first cycle, they will infuse you with each drug during one long hour, and watch you for another hour after that.

After that first cycle of THP (or TCHP), they will put these drugs (each one) during half an hour and will watch you for half an hour. Docetaxel/Taxotere will always be given for one long hour.

The good news is that the needle they put in your arm is smaller than the one they need to use while giving you FEC.

From day two I would still get mucositis (like a constant but mild sore throat).

On the next day of my first THP cycle (but 4th cycle of chemo overall) I had a very weird sensation: like if I breathed deeply I would get a chest pain. I thought it was something like a chest infection (it felt like it!), but I did mouth washes with Benzydamine and the pain would weakened, so I understood it was mucositis, so the pain must have been in the throat. It was so intense!

Overall, I didn´t experience the exhaustion I did have with FEC right after the infusion, and for about two to three days I was OK, so in that sense it was such a relief to start this other treatment.

Days 4 and 5:

However, I would experience tiredness on day 3, and from my 2nd cycle of THP my face would experiment a deep change that was quite scary… it was like my eyes were suddenly swollen and sunk into my cheeks. I didn´t recognise my face in the mirror. This happened in all the THP cycles, and it would last for about three days.

As I said, this weird effect occurred with every dose of Taxotere, but on my 2nd cycle (5th cycle of chemo in total) I had an appointment at hospital just three days after receiving the chemo, what made me go to the toilet several times (being nervous helps me going to the loo a lot…), and I noticed that my face would recover faster this time… Then I decided to read more about Taxotere (in the manufacturer´s website) and I learnt that Taxotere gets out of your system not through the urine (like it happens with FEC), but through the poo! (sorry, I meant excrements). At least 80% of it comes from… the brown stuff. So the more you go to the toilet after chemo, the better!

On day 3/4 I also got a skin rush in my neck and chest (both sides), which apparently is really common with Taxotere. On day 5 this was so itchy and unbearable that I finally asked for help calling one of the breast oncology nurses. She got me a prescription of Benadryl (in pills) and Bethametasone (cream), which worked absolutely great and very fast. Within a day or two the rush had gone.

Day 6:

On Day 6 I was absolutely scared when I had a lump of the size of an egg in my neck, on the side I received the chemo. It happened when I was chewing a strong(ish) meat.

This is called sore glands, and can be caused by Taxotere, even though an experienced oncologist told me that she had never heard of this side effect. Well, it is clearly stated under the Taxotere possible side effects, and I had it, so… perhaps she needs to read a bit more.

If this happens to you, don´t be scared. It will go away after a day. Just try to eat a soft diet around your first week.

Day 7:

A week after starting THP I started to get a runny nose, like 24/7. This is caused by Herceptin and it will be with you the whole year, while you keep on receiving Herceptin injections. I basically cannot go anywhere without a tissue. Like I don´t ever have a break.

OK, I have to say that two months after finishing my chemo infusions the runny nose has got better (although I still get 2 ml Herceptin injections, and that is why it hasn´t disappeared completely).

Day 7 to 9:

All of a sudden, I was quite tired around these days.

Days 5 to 15:

Around the 5thday after my infusion I started having a sore mouth, but I did not have anything visible in my mouth. My taste just changed and anything would hurt me. My tongue became so red from day 5 that I felt like taking it out. Thank God I didn´t. From day 9 to 14 I finally had visible white heads (mouth ulcers/canker sores), so I could apply Alum powder on them and leave it for a minute, as explained before in this article.

This was for me the worst side effect of all, as I love eating. I still ate (and gained weight), but with much suffering, I have to say.

Day 17:

Around this day, I got a bit of a pinky blood from my nose.

Other side effects:

– Soon after my 1st cycle of THP my eyebrows and eyelashes started falling. This deserves another post (coming soon), but you must know that yes, with Docetaxel/Taxotere, eyelashes and eyebrows fall, if not completely, almost.

My eyes were all the time red and irritated due to Taxotere, and also because of the eyelashes falling continuously.

Putting two eyedrops of Hypromellose 0.3% on each eye, three times per day, for the duration of the THP chemo helped me significantly. However, my eyes only went back to normal six weeks after finishing all chemotherapy treatments.

After my 2nd cycle of THP my nails started turning yellowish, like if I was a heavy smoker, as I explained. 9 weeks out of Chemo and my nails are still a bit yellowish on top, but I kept on using Nailtiques Formula 2 constantly and cutting them short, so the yellow part can completely disappear soon.

I am not going to lie. The first dose of THP was really hard. I got many different and weird side effects. But that helped me avoid all these in the 2nd, 3rd and 4th cycle of Taxotere, so there is always a positive side to everything.

It is important to know that sometimes, even though you get some side effects after one cycle, you might not have any of them after the following one. For example, on my 2nd cycle of THP, to avoid the horrendous skin rush I took Benadryl on my second day after the infusion. I didn´t get ay skin rush, then. But on my 3rd cycle of THP I didn´t take anything (I decided to wait and see), and I didn´t develop any rush anymore.

Finally, after my last cycle of chemo (4th of THP and 7th in total), I did get red spots over my arms, legs and part of my back and chest (everywhere, really…). I thought the Taxotere caused this. However I have now realised (two months after finishing chemo) that it is the Herceptin! However, I don´t mind if this is the only side effect I get from the Herceptin (apart from the runny nose, of course). As long as my heart doesn´t get affected, I´m happy!

The good news is that most of these side effects will disappear after finishing your infusions of Taxotere. As I said, the runny nose will continue because Herceptin causes it, but all mucositis symptoms, the tiredness, the annoying ulcers, and the swollen face… all of that will go away pretty soon after you finish.

What doesn´t go away that fast is the hair falling. Still after finishing Taxotere, people report to keep on losing eyelashes, eyebrows, and head hair. It can take a while to finally see your eyelashes coming back for good. For some girls, it could take up to six months! Hopefully, not your case.

Another very weird side effect caused by THP (after my 3rd cycle) was an annoying twitchy eye, that only stopped one month and a half after completing chemo…

After the 3rd cycle of THP I also got a very blurred vision that thought would last for life (I actually thought that I was becoming blind). It also stopped about the same time… around 5 to 6 weeks after chemo.

Remember to follow the tips given before to avoid neuropathy caused by Docetaxel/Taxotere. I didn´t list this side effect here, because I didn´t get any.

Any questions, please ask!

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