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Episode #17 - Chemotherapy 101

Steve Abbott:

Hello everybody, and welcome to episode 17 of our Medical Minute Podcast. The first thing I want to do today is welcome a whole lot of new viewers, I hope, at least. So, we went from about 50 to the right at 300 in a little over a week. So yeah.


Sherry Hughes:

Drum roll. Applause, please.


Steve Abbott:

It's been a lot. It's been a lot of work but a labor of love. So anyway, we're getting there, so if you can keep passing the word out, that would be great. We love what we're doing here, and we think it's really important. So anyway, so Jill, we've been talking about this guy, this John Doe type person that has this metastatic case of prostate cancer lately.


Jill Hunt, CNP:

John Doe.


Steve Abbott:

John Doe. John Doe. So we've walked through all these different types of precision medication. I forgot to point out this is our first time trying to coexist as a three-person team.


Sherry Hughes:

Yeah.


Steve Abbott:

Without the right kind of table. So we're waiting on that and then meanwhile, our producer is now an interior designer as well, you can see behind us. But anyway, going back. We've covered these different types of precision medicine, precision oncology, whatever you want to call it. And then we'll take a little bit of a lull until we get what will be really the final piece of important information before John Doe, his treatment plan, gets developed.


Steve Abbott:

In the meantime, I wanted to circle back; we've kind of touched on this a little bit, but it's something that affects so many people, and so it gives us a chance to bring on Sherry Hughes today. She's going to be a key member of our team going forward. One of the things I wanted to talk about is chemotherapy. Jill and I have touched on that in various ways, but I wanted to really limit the discussion today to chemo from both a clinician's point of view and from a patient's point of view.


Steve Abbott:

I wanted to start out, oftentimes people will hear a term, and they'll say, oh, it's a systemic therapy. So what is systemic therapy, and why is chemo considered to be a systemic therapy?


Jill Hunt, CNP:

Okay. So the term, you'll hear different targeted or localized treatments. Those are often used when using radiation. And why that term is used is because it's point and shoot; you have a specific spot that you are targeting, and that spot only is being treated.


Steve Abbott:

Okay.


Jill Hunt, CNP:

Okay. So when you start talking about the term systemic therapies, it's it is a therapy that goes system-wide.


Steve Abbott:

Okay.


Sherry Hughes:

Chemo.


Jill Hunt, CNP:

Chemo, yeah. Or immunotherapy.


Sherry Hughes:

Yes.


Steve Abbott:

Yeah.


Jill Hunt, CNP:

But yes.


Steve Abbott:

Okay. So then, and I think we hit on this one time before years ago, I read a book, it was called The Death of Cancer.


Jill Hunt, CNP:

Mm-hmm (affirmative).


Steve Abbott:

And I think it might have been written by Vincent DeVita; I can't remember who the author was.


Jill Hunt, CNP:

It was.


Steve Abbott:

Okay. Part of what that dealt with, even though it's written from an optimistic perspective about our ability to eventually defeat cancer or at least manage it as a chronic disease, also takes you through the horrors of what once was treatment.


Jill Hunt, CNP:

Right.


Steve Abbott:

So chemo sounded absolutely horrific.


Sherry Hughes:

Yeah.


Steve Abbott:

Back in the day, when it was your grandpa's chemo. And so-


Sherry Hughes:

It's a little bit different now. But still, it is a challenging treatment.


Steve Abbott:

Yeah. Yeah. And we've come a long way, right?


Sherry Hughes:

Oh yeah.


Steve Abbott:

But I was thinking maybe what we do is maybe you can get both kinds of speak to this from a clinical view, Jill, and then from a patient's point of view, we may have to do a second episode, but tell me, how do you feel, what have you seen that's changed even in your close to 30 years, I think of experience 20 plus years experience?


Sherry Hughes:

20 plus.


Steve Abbott:

20 plus, all right. That's right, 30 would be since birth. But anyway, in your 20 plus years of experience, what have you seen change for the better? Why don't we focus on the positive? Then maybe Sherry can kind of take us through her recent experience only two years ago about that.


Sherry Hughes:

Okay. So there have definitely been a lot of changes even in the last 20 years for all of the different treatment regimens that are available for patients. But with all of that hope, I also don't want to belittle the fact that those grandpa chemotherapies do still exist. The difference is that they're not as often used as frontline treatment anymore.


Sherry Hughes:

The advances that we've made in treatment plans definitely have made it, so we are seeing more durable responses, which means patients go longer without having a recurrence or without having their disease get worse or come back.


Sherry Hughes:

But the other piece to that is the side effect management is a lot better, so it's a lot more tolerable.


Steve Abbott:

Yeah.


Jill Hunt, CNP:

With the right management and depending on the different treatment plans, I mean, and Sherry, you can speak to this. Patients can work full time.


Sherry Hughes:

Yeah, I did.


Steve Abbott:

Yeah.


Sherry Hughes:

I did, and it was surprising to me because when you first hear that you're going to have to endure or take chemotherapy, you think you don't really know what that is as a patient. You know that you're going to go in, and you're going to get an infusion, but you don't really know what to expect. My first chemo treatment, the process started at about eight in the morning, and I didn't leave until seven in the evening.


Jill Hunt, CNP:

Mm-hmm (affirmative).


Sherry Hughes:

It was very intensive because I had a series of cocktails.


Jill Hunt, CNP:

Mm-hmm (affirmative).


Sherry Hughes:

So oftentimes, you think of chemo as a treatment. It is, and as Jill said, it's systemic; it's through the entire body, but your body cannot ingest all of that medication all at once, so it's a lot of stops and go. And I had a series of six different cocktails. Those are drugs, medications that are used together to mix together, to come up with your treatment for your chemo.


Jill Hunt, CNP:

Definitely not served with an umbrella.


Sherry Hughes:

Not served with an umbrella. Limavady, Paraplatin, Taxotere, Perjeta, you name it, I had like all the gamut. And you have to get it infused, and you have to wait a little while. Then you have to get your system flushed out with saline, and then you have to start the next treatment.


Jill Hunt, CNP:

Mm-hmm (affirmative).


Sherry Hughes:

And they do that so that they make sure they minimize the potential for you to be experiencing immediate side effects. Or maybe you have some kind of a reaction to the medication.


Jill Hunt, CNP:

Yeah. A lot of the medications, even with what they call the pre-meds, which is usually the first little bag of cocktail that you get, kind of your appetizer, it's a combination of an antihistamine, so you get medications like IV Benadryl, and you get asteroid.


Sherry Hughes:

Yes.


Jill Hunt, CNP:

And you get medicine like Pepcid, and it's all mixed into one bag, and it's all there to help prevent,


Sherry Hughes:

To help you.


Jill Hunt, CNP:

the side effects as well as the infusion reactions, and then usually there's also an anti-nausea mixed in, and they've created anti-nausea medications for cancer patients that now you get infused with it, and it lasts for three days.


Sherry Hughes:

Yeah. Yeah. I was rather surprised because of my first chemo treatment; I was thinking, okay, because I had watched my mom many, many years before go through it, and her response, her body's response was not like mine.


Sherry Hughes:

So hence, we have come a long way, but after my first chemo treatment, I thought that I would be laid up, I wouldn't be able to do anything, but I was like the Energizer Bunny because I had so many of those other medications that were infused to help my system, recover from it that I was running all around, doing things and my husband was saying, you got to sit down, you got to rest. Therefore, everybody though will not experience the same type-


Jill Hunt, CNP:

Right.


Sherry Hughes:

-of recovery. It all depends on, also, what you're doing to treat your body right and to treat your body better while you're going through the chemo, eating, nutrition, drinking lots of water.


Steve Abbott:

Boy. Here we go again.


Jill Hunt, CNP:

Mm-hmm (affirmative).


Steve Abbott:

Yeah. Lots of water. I know.


Sherry Hughes:

Lots of water.


Steve Abbott:

Yeah, I know.


Sherry Hughes:

I know water can be, I think, described as having medicinal purposes as well.


Jill Hunt, CNP:

100%.


Sherry Hughes:

Very good for you.


Jill Hunt, CNP:

How much of the body is made up of water?


Sherry Hughes:

Yes. 78. Is it 78% or 70%?


Sherry Hughes:

It's 70 plus percent.


Steve Abbott:

Okay.


Sherry Hughes:

Okay. I think 78.


Jill Hunt, CNP:

Yep. Well, and to speak to what you had said, Sherry, not everybody responds to the treatment the same way, and that is where the communication with the healthcare team is huge. We definitely are not in the age of your grandpa's chemotherapy, where we only have a very limited amount of options to manage the side effects.


Jill Hunt, CNP:

The amount of a number of medications that are out there that can treat chemotherapy-related nausea and vomiting, the list is endless. I'm constantly telling patients if this doesn't work for they need to call and tell me, do not wait until you come in for your next visit and say, well, I'll just talk to her when I see her, there is no sense in being miserable.


Sherry Hughes:

Yeah, you don't have to. I mean, really.


Jill Hunt, CNP:

No.


Sherry Hughes:

For me, I actually started to feel the effects of chemo, probably around 72 hours after I thought it would almost be immediate, but my first.


Jill Hunt, CNP:

That little bag of appetizer that you get, that's what has stuck with you for those.


Sherry Hughes:

Yes.


Jill Hunt, CNP:

Seventy-two hours and patients are almost amazed when I tell them, okay, look; you're going to come in the day of treatment, you're going to feel fine. You're going to wonder if we gave you anything right.


Sherry Hughes:

Right.


Jill Hunt, CNP:

The next day, you're actually going to be concerned because you're going to clean your house, those steroids -


Sherry Hughes:

That's what happened to me.


Jill Hunt, CNP:

- are beautiful things. And then you're going to wake up the next day, and you're going to start to feel a little wilty.


Sherry Hughes:

Yeah, about day three. But it is important that with each day that you're again treating your body, right.


Jill Hunt, CNP:

Correct.


Sherry Hughes:

That you're resting even when you feel like you don't need to rest that you're in that water, I'm telling you drinking plenty of it, because what goes into the body, you got to flush-


Jill Hunt, CNP:

- it's out.


Sherry Hughes:

You need to flush that out of your system. And that will help you recover a little faster. It's not the end all be all because you are getting some very heavy doses of medication there, but it does go a long way.


Steve Abbott:

All right. So then message received, even though it's not all about me, but sometimes it is, right?


Sherry Hughes:

Or John Doe.


Steve Abbott:

Or John Doe, that's right.


Sherry Hughes:

And you haven't had chemo at this point, right?


Steve Abbott:

Not yet, hopefully not for a while. So one of those anti-nausea drugs is Reglan one?


Sherry Hughes:

Well, Reglan is one it's not one of the top ones that's initially used, but-


Steve Abbott:

I just wanted to show my immense knowledge of things, but it's kind of a half hit there, not really. I didn't pick the right one, but anyway, whatever. So you know what I call six cocktails?


Sherry Hughes:

Oh, okay. I'm waiting for it.


Steve Abbott:

A good start.


Sherry Hughes:

A good start. Okay. A good feeling. A good day. Right. And a good night too.


Steve Abbott:

All right. So anyway, lots and lots and lots to talk about. So I think the key point is for this episode, and then I'm now convinced that we should do a second one.


Jill Hunt, CNP:

Okay.


Steve Abbott:

Because there's a lot, there is a lot to talk about, but I think the key point is, and I wrote this down cause I want to forget it. More people are living normal lives with cancer.


Jill Hunt, CNP:

Yes.


Steve Abbott:

We're finding it earlier.


Sherry Hughes:

Mm-hmm (affirmative).


Steve Abbott:

And we're beating it more often than ever before.


Jill Hunt, CNP:

Yes.


Steve Abbott:

Would you, would you both agree? So in time, we'll bring some actual real-life patients on other than just Sherry to talk about maybe some of their experiences as well.


Sherry Hughes:

Yeah. That's important because everybody's experience is not the same.


Steve Abbott:

Exactly.


Sherry Hughes:

That's not to say you're going to have a bad experience. We want you to have the best experience that you possibly can when you're going through chemotherapy. And I just want people to know that you can manage it. It is very manageable. There will be times that you feel like it's kind of taking over, but that's when you take a step back, and you rest your body, and you treat your body as best as you can. You recover, and then you move forward.


Steve Abbott:

Yep.


Jill Hunt, CNP:

And I don't ever want any of our viewers to think that we're painting a picture that cancer and its treatment is sunshine and rainbows. We know that there are days that it's hard and some days that it's harder than others. The whole point of all of this is to educate and to help patients know that there are strategies out there to make this manageable.


Sherry Hughes:

I like that the strategies because, again, it's not a size fit all disease, and the treatment is not that either. Again, not painting a rosy picture, but letting those that are going through it know that you can manage and that you can get through it and that you can even work through it. Some folks will experience some things where perhaps they're feeling more ill than others, but it is very manageable.


Steve Abbott:

All right, Chris is writing something. I hope we're not getting in trouble. Okay. All right, good. All right, everybody, we will be next Wednesday at noon; we may be talking about chemo, or we may be talking about John Doe's test results, but we'll have something to talk about. And hopefully, more people will share, like, and subscribe this coming week, and we will see you back here next Wednesday. Thanks, everybody.


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