Into the Final Fast

I can hardly believe it, but I’m now 31 hours into the final fast before my (hopefully!) last chemotherapy session tomorrow (29th October 2015). In Blog 10 I felt it was too early to discuss how the fasting was going for that treatment, and that I would update you today.

So,  I can report that I stuck rigorously to my six day fast (350 calories-a-day for two days prior to treatment and for four days afterwards) and, whether cause or correlation, my digestive tract has had an easier ride this time overall. I have also had less severe pain, although I do have some ‘peripheral neuropathy’ (or numbness) in the fingers and feet, along with some leg pain, which would probably be expected to go by now. On that basis, we have agreed to reduce my chemotherapy dose by 20% tomorrow because my treatment outcome will not be affected, and that numbness can be permanent if not managed properly.

Keeping it Simple

When I started fasting I was preparing quite elaborate soups and stews which were delicious but, now I am receiving treatment every two weeks and am starting to feel very tired, it has been quite tricky to maintain.  So, my approach now is to keep it very simple, focusing on protein and vegetables for all meals, including breakfast. Sample meals include:

Breakfast (88 cals)

• Soft boiled egg
• 80g celery cooked in stock and cut into dipping ‘soldiers’ (with celery salt to taste)

Lunch (110 cals)

• 200g Yorkshire Provender Pea and Spinach Soup

Dinner (147 cals)

• 100g grilled chicken
• 50g steamed green beans
• 30g steamed broccoli
• 100g steamed spinach
• 60g steamed carrot

It’s pretty simple huh?! But doing it this way you actually get a really good plateful of food and, being simply prepared, it is gentle on the digestive system.

If you are vegetarian you could of course substitute the chicken for Quorn or a similar high protein product.

Much Reduced Surgery

After a summer of chemotherapy and fasting, I was feeling pretty nervous before my meeting with the Royal Marsden breast surgery team last week to discuss the surgical options open to me. Would the weeks of sickness and pain have been worthwhile?

Given that the starting point was a radical mastectomy back in June, I am so relieved to report that my surgical team are confident that they can remove the cancer by carrying out much reduced surgery on just one side.  What’s more, the scan they were working from was taken before my last two rounds of Taxol chemotherapy, so we can expect the tumours to have reduced even more by the time I have surgery on 26th November.   The neoadjuvant chemotherapy has done its job.

Thanks again for reading… If you are going through a similar experience I wish you all the very best.

Della x

Disclaimer:

The information contained in this post or any other post on this blog is based on personal experience and should not be viewed in any way as medical or other advice. If you are considering fasting for chemo, please consult your healthcare provider.

Copyright © 2015 Johnson

In Blog 9 , I talked in more detail about the rationale behind the 350 calories-a-day fasting approach.  In that blog I reported that, having started to receive fortnightly Taxol infusions, I had broken fast early because the clearance time for Taxol is relatively quick. I also felt ready to eat (low blood sugar and low mood!).

I did however come to regret this decision later in the week as I experienced quite strong nausea on day 5 and gastrointestinal tract disturbance on days 9 and 10. Clearly we will never know for sure whether this would have happened anyway, but this week I am going to fast for the full four days after chemotherapy to see if this makes a difference. I hope this is not frustrating for readers, but I think you will appreciate that this is a personal experiment and I am testing out approaches as I go. I will bring together all my thoughts when my chemo regime has come to an end, and provide a list of general tips for handling chemotherapy, based on my own personal experience.

Side Effects of Taxol

As I now have two Taxol treatments under my belt, I think it’s useful to report on my experience of side effects, compared with the side effects anticipated by Macmillan Cancer Support:

Common side effects of Taxol according to Macmillan Cancer Support	Side effects I have experienced whilst on Taxol
Infection	No infection to date for either EC or Taxol chemotherapy. White blood cell count 3,200 per cubic mm of blood, which is slightly but not significantly below the normal range of 4,000-11,000.
Bruising and bleeding	Not applicable
Anaemia	Red blood cell count 3.58m per cubic mm of blood, which is slightly but not significantly below the normal range of 3.8m-5m.
Nausea	Day five, the day after breaking fast one day earlier than planned.
Upset stomach	Days nine and 10
Sore mouth	Not applicable
Numb hands and or feet	Slightly numb and tingling feet gradually improving.
Tiredness	Some tiredness, but not excessive.
Hair loss	Hair loss started with EC chemotherapy and has gradually continued throughout the programme. As of today approximately 90% of my hair has fallen out, and my eyebrows and lashes are starting to thin.
Muscle and or joint pain	This has been the main feature of Taxol treatment for me. Inflammation controlled using Ibuprofen supported by 30mg Cocodamol and Tramadol as required.
Nail changes	Not applicable.

 Exercise and Complementary Therapy

To help mitigate side effects it is common for people to seek complementary therapies during cancer treatment. To be honest I’ve not felt well enough to plan for this kind of treatment until recently.

But this week I have been lucky enough to have had an aromatherapy massage at the Royal Marsden using a combination of black spruce and lavender oils – highly recommended. It was fantastic to be in the hospital and on the receiving end of a gentle treatment that didn’t involve needles or pain!

I have also enjoyed acupuncture at the Yuan Centre in Colliers Wood. I had just four needles during the treatment, two of which were to support ‘nourishment of the blood’, and two were to support the immune system.

Finally, inspired by four of my dear friends who have recently run marathons, I decided to sign up for a marathon too. Only joking! No, one step at a time…. But I did download one of the ‘Couch to 5K’ apps on my mobile phone and will gradually build my fitness that way. It may be slow going until after the chemotherapy has finished as leg and foot pain is a feature of Taxol and I did have to take painkillers after my first jogging session, but the intention is there!

Next Week…

My penultimate chemotherapy session is tomorrow and my last session is on 29^th October 2015. I am not relishing the next week, but I am armed with painkillers and know what to expect. I am also heartened by today’s scan which showed that my two tumours appear to be still shrinking (the smallest is now approximately 3mm and the larger one is approximately 1cm).  I’m meeting with my surgeon on 22nd October to discuss surgery options (please keep your fingers and toes crossed that the chemotherapy has been effective enough to remove the need for full mastectomy…).

Onwards and upwards!

Thanks again for reading, I love getting your comments and feedback.

Della x

Disclaimer:

The information contained in this post or any other post on this blog is based on personal experience and should not be viewed in any way as medical or other advice. If you are considering fasting for chemo, please consult your healthcare provider.

Copyright © 2015 Johnson

Since Blog 7, when I posted three emerging principles of Fasting for Chemo, a few people have asked me to explain in a bit more detail the thinking behind the first principle: 350 calories-a-day for six days.

So, I thought today it would be useful to discuss this with you and provide links to the papers that informed the decisions I have taken over the past few months.

Please check out Further Reading for references.

Medical Advice:

From the outset I told my doctor at the Royal Marsden that I was fasting for chemotherapy, and their attitude was that, whilst there is some evidence to suggest fasting might help, it is not Royal Marsden policy to support fasting and so, as long as I was getting a well-balanced diet overall, I was to do whatever I needed to do to get through treatment.

I should also confess at this point, however, that I have had medical and scientific input from someone close to me who is not only a medical doctor, but who also has a PhD in molecular biology. My approach is therefore supported not only by emerging scientific research, but is also informed by a medical professional who knows and understands my personal situation.

Why 350 Calories-a-day?

Fasting has been shown to be an effective way of lengthening life span, reducing cell damage, enhancing stress resistance and delaying  aging and age-associated illnesses such as cancer in various species, including mice, rats, and non- human primates (McCay et al, 1935; Weindruch et al, 1986; Masoro, 1995; and Colman, 2009).

Moreover, a large cohort study with over 2000 participants investigated the safety of fasting in patients with chronic disease (Michalsen et al., 2005). In this study, the authors determined that eating 350 calories a day was safe and considered by many of the participating subjects to be beneficial to their illness.

Why Fast for Two days or 48 hours Prior to Chemotherapy?

Until recently these two aspects had not been brought together and tested in humans, but in 2009 a small study was carried out with 10 humans with a range of cancers who voluntarily fasted for a total of 48 to 140 hours prior to and/or 5 to 56 hours following chemotherapy. They reported a reduction in common chemotherapy-associated side-effects such as vomiting, diarrhoea and fatigue. Significantly, there was no evidence that fasting protected tumours or reduced the efficacy of chemotherapy. The authors note that their work is not meant to establish practice guidelines for patients undergoing chemotherapy but that only controlled-randomized clinical trials will determine the effect of fasting on clinical outcomes including quality of life and therapeutic index (Safdie et al.,2009).

Using previous studies and my personal medical advisor to guide me, I decided to fast for 48 hours prior to treatment, which not only seemed to be a realistic fast duration but also allowed the body sufficient time to enter a state of ketosis, which is the aim of fasting for chemotherapy.

Why Fast for Four days after Chemotherapy?

The treatment path I followed initially was four sessions of EC Chemotherapy, which comprises two medications: Epirubicin and Cyclophosphamide. The half life (or time it takes for half of the drug to leave your body) of Epirubicin is approximately 30-40 hours and the half-life of Cyclophosphamide is approximately 3-23 hours although results vary between individuals depending on their age and health.

Based on this information, fasting for four days or 96 hours after treatment seemed like a good way of ensuring my body had cleared as much of the drug as possible without restricting my diet for too long, which may have other unforeseen consequences.

A Flexible Approach

When I started this blog I was undergoing EC Chemotherapy and I had planned to eat 350 calories for two days prior and two days after chemotherapy, increasing to 500 calories for a final two days. But, after experiencing more extreme side effects when I increased my calorie intake, I decided to keep calorie consumption at 350 for six days for the duration of my EC Chemotherapy programme.

I have now finished my EC Chemotherapy regime and have started Taxol, which has a much quicker clearance rate, indeed, 50% of the drug Taxol is excreted between 3 and 51 hours after treatment, depending on the individual’s overall health.  After my last treatment on 1^st October, I was prepared to fast for the full four days as usual, but by day three I felt ready to eat again. So, I broke fast 24 hours early and, with the exception of a bout of nausea, I am eating normally which, compared to previous treatments, is very early in the cycle.

Based on this personal experience, if you are considering fasting for chemotherapy, you might consider checking the clearance rate of the chemotherapy medication(s) you are taking and adjust your fast time accordingly.

Randomised Trials Needed

Whilst there is emerging evidence in this interesting field, it is abundantly clear that large scale, controlled and randomised trials are required. There has been encouraging news in 2018 that fasting can improve quality of life and reduce fatigue but clinical trials are ongoing.

Della x

Disclaimer

The information contained in this post or any other post on this blog is based on personal experience and should not be viewed in any way as medical or other advice. If you are considering fasting for chemo, please consult your healthcare provider.

Copyright © 2015 Johnson