Less Chemo Fatigue. Why?

The latest round of chemo produced significantly less chemo fatigue than normal. Usually, the fatigue begins on Friday evening after my Wednesday infusion and continues through Saturday and Sunday, and then lifts through about mid-week, so that by Thursday, I am most of the way back to normal. This time, I had only minimal fatigue on Saturday and Sunday. Why?

Three possible factors come to mind:

1. Current thinking about chemo fatigue suggests that it is caused, at least in part, by substances called cytokines that are released into the bloodstream by dying cells. It's like the body is telling you, “Hey, you're injured. Find a place of retreat where you can lick your wounds and heal.”

I have an hypothesis that when I begin a new series of chemo after a break (11 months this last time), the chemotherapy agent, pemetrexed, has lots of vulnerable cancer cells to kill, so lots of cytokines are released producing lots of fatigue. Given that pemetrexed only works on actively dividing cells, not all vulnerable cancer cells are killed with the first infusion, so there is a new crop of dividing cells ready to be killed by the next dose three weeks later. It seems to me that there would be fewer cells left that are sensitive to pemetrexed with each infusion; consequently, the fatigue would fade in severity. I have my next CT in a couple of weeks, and my guess is that my tumors will not have shrunk much, if at all, because six round of pemetrexed have gathered all the low-hanging fruit.

2. Perhaps the extra energy from the supplemental oxygen reduced the fatigue.

3. We started a new tradition this spring, and Jana makes me a “chemo cake” each time I have an infusion. This time, however, I got a chemo car instead of the cake. I bought a red, first generation Mazda Miata sports car. Do you think the new car helped fight the fatigue better than a cake?

Hello 2 O2

It's been a while since I've added anything to the blog, but that's because things have been pretty routine. However, since we've been doing more active work outside this summer I've been bothered more by a shortness of breath than before. For example, we recently removed recycled rubber from the walkway between the patio and the back yard, rearranged/replaced stepping stones, and adding pea gravel between the stepping stones. I found that only a little effort made me very short of breath and fatigued, and I had to take frustratingly frequent breaks. When we went bird watching with friends, I typically did not try to walk with the others because of my shortness of breath. Even light exercise like cooking turned me into a certified “mouth breather.”

So when I went to see my oncologist prior to my latest round of chemo, I asked to be evaluated for supplemental oxygen. I took a walk with a nurse, and my pulse oxygen level quickly dropped to the point at which I qualified.

The oxygen equipment arrived that evening—a two-part unit that contained an oxygen concentrator and compressor, two large and two portable oxygen tanks, a sort of pack with a shoulder strap for carrying a portable tank, and several nasal cannulas.

I placed the oxygen concentrator downstairs in the finished part of the basement. The concentrator removes O2 from the air, and a tube attached to the concentrator provides me with oxygen when I'm working at the computer in the workroom, doing something at my workbench in the basement, or watching TV in the family room. The compressor is connected to the concentrator and used to fill the small oxygen tanks for use upstairs and outside.

It's been almost two weeks since I got the oxygen equipment, and my use of it is still evolving. When I requested the evaluation, my concern was to have oxygen while active—doing light exercise around the house, more strenuous activity outside, or while walking in the mountains. It turns out that I use it more while sitting quietly in the house reading, working on the computer, and watching TV. While I don't feel like I really need it at that time, my pulse oximeter shows that my O2 level is below the expected 94% level. While working in the garage, I wheeled one of the larger tanks out there and found that worked better than carrying around the portable tank although it was something of a hassle working like a diver at the end of a long tube, but I enjoyed not getting short of breath. I am interested in seeing how my use changes with experience.

It's good to have the oxygen, but disappointing to need it.