Cancer, Chemotherapy, and Monotasking
In the summer of 2017, I was diagnosed with cancer. Stage 2 primary mediastinal diffuse large b-cell non-Hodgkin lymphoma to be precise.
Fortunately what I had was treatable following a protocol called R-EPOCH. I went through 600 hours of chemotherapy over 4 1/2 months (my particular treatment required me to go into the outpatient treatment center 6 days in a row, and be connected to a portable chemo pump for 5 of those days). During that time, and for months after, I had every side effect you might associate with chemo. I took extensive notes about what worked and what didn’t work for me.
Over the years, I have shared a PDF of my “chemo tips” with anyone going through treatment. My tips include ideas for how to mitigate various side effects and perhaps feel just a little better and a little more in control of what is somewhat inevitable going through such a powerful course of medicine.
I’m sharing these tips now, largely unedited since 2017 in the hopes that they can be helpful to a larger audience.
FYI, the chemo drugs I was on were Rituximab, Adriamycin (also known as Doxorubicin), Etoposide, Cytoxan, Vincristine (also known as Oncovin). I also was given Benadryl, Aloxi, Emend, Dexamethosone, and Bactrim to manage various side effects and risk factors.
Thankfully, I have been cancer free for over 4 years now.
DISCLAIMER: This is not medical advice! These are notes that I took from my own experience as a cancer patient. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment.
Chemotherapy Tips (11/17/17 version) by Thatcher Wine
Overall I took the approach to chemotherapy that is was my full time job every day to work on problem solving, improving how I felt, looking for little solutions that would help me feel 2–3% better here and there. [Note: I hadn’t yet written a book about monotasking, but in hindsight, this was a formative monotasking experience. I was still working (running my company juniperbooks.com, and parenting (kids were 8 and 11 at that time). I didn’t slow down enough, but I did monotask getting treatment and managing the side effects.]
Constant adjustments are required, things that work one week may seem completely ineffective another week.
Morning Routine
- Warm salt water/baking soda mouth rinse and throat gargle — helps with mouth sores and overall mouth care
- Drink aloe vera juice — 1–2 ounces. Aloe is good for mouth sores and soothing the stomach lining. Swish around mouth then swallow.
- 15 minutes later — warm lemon juice with water and honey, about a half cup — good for making your body alkaline and nourishing your throat, which was very dry for me.
Stomach/GI Care and Digestion
Chemotherapy destroys your stomach, there is pretty much no way around that. You have to keep eating and repair your digestive system little by little as you make your way through it.
- Fresh fruits high in natural digestive enzymes were sometimes helpful — papaya was the best for me, then pineapple and mango. I sometimes took Digest Gold digestive enzymes.
- I took probiotics in non-treatment weeks and on alternating days from my antibiotic (was on Bactrim for the duration of chemo). HLC Maintenance was the formula I consumed. I suspect that the healthy flora never really took hold in my gut, but I still did it, and plan to truly rebuild my gut after chemo is complete and I go off the antibiotics.
- Most days I started my day with a bowl of cereal or oatmeal for breakfast with some added fiber (ground flax seed or chia seed) plus some fresh blueberries, bananas and nuts
- During chemo I couldn’t really stomach my usual vitamins, I did try to take a multi-vitamin every day with breakfast, then during non-treatment weeks I took additional vitamins when I felt up to it, always with a good meal (see further below for supplements)
Hydration
- This may be my #1 tip — drink tons of water and a mild electrolyte mix constantly. Yes, I had to pee about every hour every day and night, but I think it really helped keep flushing the chemo through my system and nourishing my body with fluids
- For the 4 months of treatment, I carried two refillable glass water bottles with me everywhere I went — one with water and one with Skratch Labs Daily Electrolyte Mix Lemons + Limes — available on Amazon, at Whole Foods, etc. — you put a scoop in a bottle of water and shake, it is low in sugar and tastes great. I have heard from other chemo patients that water tasted bad and this mix saved them!
- I counted my daily water consumption at 7 x 16oz bottles = 112 oz, plus 2 x 16oz electrolytes = 32 oz, plus about 2 cups of tea a day. It’s more than one typically would drink but it can only help.
- Anytime I had heartburn symptoms or just feel the slightest nausea or muscle pain, I had a few large swigs of water and usually made most of it go away. Sometimes just for a few minutes and then I’d drink more water or electrolytes and repeat.
Nutrition in General
Although my digestion was funky, I had a healthy appetite throughout chemo and actually put on 10 lbs. Not eating will only make the side effects of the chemo stronger, it will take longer for the waste to be eliminated from your system and your blood sugar will be off causing difficulties with energy levels, mental and physical balance.
- Find your comfort food. I think it’s good to have one meal that is a go to when you don’t feel well and don’t want to eat. Something you don’t have to think about whether you are hungry, what you want to eat or not eat, etc. — basically a mindless comfort food that you or your caregiver can just make and put in front of you. For me it was white rice (frozen pack easy to make) with Epic bone broth (Turkey Cranberry Sage) and Bubbie’s Sauerkraut. Heated up for 90 seconds. Easy to digest, full of protein, b-vitamins and probiotics. I ate this almost once a day for 4 months. Find what works for you, have it around and just put it in front of you, no conversation required. [Note: I am mostly vegetarian now, and occasionally eat some fish.]
- Get a cookbook you love and work your way through it. For us, it was The Cancer-Fighting Kitchen, Second Edition: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery by Rebecca Katz. I marked off the recipes that sounded and looked good to me, anytime someone asked what they could make I would refer them to the cookbook.
- Go alkaline when possible — it creates an environment in your body that is more healthy and less conducive to cancer growth. I loved the Green Goddess smoothies (kale, lemon juice, ginger, and more) from Whole Foods, but only on some days.
- Eat lots of Veggies — “eat the rainbow” — yams, beets, etc. for variety.
- Eat lots of Protein — bone broths are great and easy to buy these days. I’m not into red meat, I mainly eat chicken and turkey, plus fish when I felt up to it which was usually in non-treatment weeks.
- Eat more small meals, do not overeat in one fast sitting. Digestion issues caused by mixing fruits, grains, proteins too much, try to separate and digest a bit apart — still figuring this out.
- Oils are really important for the body — I did a fair amount of cooking and additional consumption of coconut oil, olive oil and avocado oil. All are mild tasting and good for you.
- Cravings — I craved greasy food at the end of each treatment week and did not think twice about indulging my appetite for fries, bacon, etc. It was like hangover food and it tasted good.
Mouth Care
- Mouth / tongue sores. The first few rounds of chemo I only got mouth sores for a couple days and then they went away. After round 5 I got a bad respiratory virus and then strep throat, the mouth sores were off the charts for about a week at the same time, making it very difficult to eat, swallow, chew, cough, everything. At that point I learned about “Magic Mouthwash” and got a prescription for it, it helps numb your mouth. I couldn’t sleep because the mouth sores were so painful, but the mouthwash helped.
- Aloe vera juice mentioned earlier is good to swish around the mouth and then swallow for stomach benefits
- Warm salt water/baking soda mix is good to swish around then spit out
Nail Care
- Rub coconut oil on your nails and cuticles, it works wonders on chemo nails!
Other Health Issues
- Know your weaknesses and be proactive, it’s likely that any pre-existing health issues may get worse during chemo.
- For me that means keeping my sinuses clear, I’m prone to infections there so I rinsed with a neti pot daily.
- I also have chronic back issues and do about 45 minutes daily of stretching/strengthening for maintenance every day no matter what. I made the mistake of getting out of my routine in the first round of chemo since the treatment was so intense. The result was that I had more problems from carrying the chemo pump and sleeping in awkward positions, plus changing my movement patterns, etc. My body was in pain and I had to work extra hard to get back to normal with everything else going on.
Alternative health support
[Ask your doctor/nurses and insurance if they have alternative support options available at a reduced price, or as part of your insurance coverage.]
- Acupuncture — I went once a week to an oncology acupuncture specialist. He had a wealth of knowledge about cancer care, helped keep my body in balance, possibly has helped me avoid peripheral neuropathy.
- Cranial Sacral — I went to a practitioner about every 2 weeks. She helped with my neck and back issues that got worse due to reduction in physical activity, change in sleeping positions, etc.
- Massage — I saw an oncology massage specialist about once every 2–3 weeks. They helped with everything, keeping energy/circulation flowing. Also a wealth of cancer advice.
Treatment Days/Weeks
- Started Miralax / laxative night before treatment and took it every day that I was on chemo (5 days in a row)
- Mild exercise every day. My goal was to to 20 minutes of exercise twice a day for first 10 days of 21 day cycle, then increase a bit for the final 10 days. This was usually on a stationary bike at home and then a walk around the block. During non-treatment weeks, I got out more and more.
- I was good about sticking to this routine for the first 2–3 rounds, then it got harder, so I adjusted my goals and was happy with any activity.
- Overall the exercise really helps to metabolize the medicines and stimulate my appetite.
- When I had heartburn, I tried a natural remedy called Tummy Zen which also worked pretty well. When needed I took Zantac for heartburn and Compazine for nausea.
- PSI bands — I wore these on one or both wrists for help with nausea.
Medical Marijuana
[consult your doctor and follow local laws!!!]
- CBD oil was extremely helpful for me to help with pain, nausea and appetite stimulation
- I took CBD oil during the day and used THC on some nights
- For the CBD oils, I tried 3 brands so far and found that Mary’s Medicinals “The Remedy” worked best for me — I think it’s because it’s a mix of marijuana and hemp oil plus cinnamon, almond oil and other things to give it a better taste and digestion. The other two formulas I tried gave me heartburn. It could have just been my chemistry but once I went on the Mary’s I felt much much better. I took 2–3 drops 2–3 times daily. This works out to 4–6 mg of CBD at a time.
- After round 4, the oil stopped tasting good to me and I switched to CBD gummies made by Wana. They have 5mg of CBD and .5 of THC in each one, because they are edibles they are a little longer lasting. You will not feel the THC or at least I did not.
- As for THC, it’s totally a personal preference whether to try it. During treatment weeks, I was on a portable pump from Monday to Friday. I found I needed more THC during the day than I would have thought to deal with the over-medicated feeling and wanting to zone out the pump sounds, etc. It also helped me get to sleep. Some days I started on the THC around 3/4 pm other days after dinner depending on how much I need to counteract the chemo and generally not feeling well. A “Sativa” strain is usually more of a daytime feel good upper, whereas an “Indica” will make you more mellow and sleepy.
- Home baked edibles — I started making my own coconut oil infused with marijuana strains that I know work well for me. Indica brownies for sleep, sativa cookies for work time, some CBD high strain baked into both.
- [Note: There are so many more products available now than there were 4 years ago. And a lot of dispensaries have staff who can talk to you about what can help you.]
- Overall, don’t do too much of anything you don’t know the dose of or how it will affect you. Adding anxiety / paranoia from taking too much THC is not fun to add to your experience.
- Definitely do not drive on marijuana, call an uber/lyft! No excuses.
Other Ideas
- I lost some of my taste for green tea , my typical morning beverage—I went to 1 cup per day on treatment days, 2 cups during other weeks. Coffee tasted good on some days even though I’m not a coffee drinker.
- Meditate 2–3x per day — I found a few meditations on YouTube for cancer and healing that I enjoyed — about 20–30 minutes each. They helped me visualize tumors shrinking and leaving my body.
- I also used the meditation to focus the chemo into doing its job and limiting the damage to other parts of my body!
- When I got the chemo hiccups, I also often able to successfully meditate them away by focusing on my breathing.
I hope these tips are helpful!
