Over Reactions

I have no idea why my body has changed so much but it has. And I tend to blame chemo for the changes. Since chemo, I have reactions to tons of things. The list of things I am allergic to has grown immensely. I am even allergic to Benadryl....

I will say its been a very long time since I was stung by a bee. That is approximately 1986 when I stepped on a bee that had come in through the wall of our kitchen in an apartment. I remember it as being extremely painful because there is no flab on your toe to absorb the venom. I ended up calling the pharmacist to ask for options.... But I also remember it going away mostly by the next day.

I was stung one other time that I remember being stung by a bee was as a child....

On Friday I had a bit of an adventure. I was feeling better so I went and poked around in the garden, did some weeding, admired my tiny little green tomatoes, and watered a little bit. My husband had gotten stung by a bee a couple of weeks ago near our rhododendrons out front. 

All of a sudden Friday, I got stung twice by bees and started running to the front door as I got stung two more times. I got stung one last time at the front door. I have I think a total of six stings: left elbow, left knee cap, left lower calf, behind my right knee, right upper calf and right ankle. As it has been so long since I was last stung, I waited a little bit to make sure I was feeling okay and wasn't having a severe reaction. That's a lot of stings. 

Now it is almost 72 hours and they itch like mad! I have tried all sorts of things to get them to stop. I did some research and got some spray on anti-histamine 

That's the bite on my lower left calf. Look how big it is. Some of the other's are even bigger. My research told me this:

"Normal local reactions

You’re likely to develop a raised welt around the sting site. A tiny white mark may be visible in the middle of the welt where the stinger punctured your skin. Usually, the pain and swelling recedes within several hours of being stung. Unless you’re allergic, most bee stings can be treated at home.

Large local reactions
“Large local reactions” is a term used to describe more pronounced symptoms associated with a wasp or bee sting. People who have large local reactions may be allergic to wasp stings, but don’t experience life-threatening symptoms, such as anaphylactic shock. Large local reactions to wasp stings include extreme redness and swelling that increases for two or three days after the sting. Nausea and vomiting can also occur." 
Most of the time, large local reactions subside on their own over the course of a week or so. Let your doctor know if you have a large local reaction after a wasp sting. They may direct you to take an over-the-counter antihistamine medication (such as Benadryl) to reduce your discomfort."

A week or so? Thanks I can't wait to itch like this for four more days. I'm still blaming chemo. Damnit.

Challenging doctors

I think I challenge my doctors. I think they they I am going to fall apart on them or something and I am not that easy to treat. First of all, I am allergic to all the good drugs - penicillins, Benadryl and prednisone, plaquenil (treats RA), codeine, and a couple other things. I even had one doctor say to me that I must be really fun to treat.

If I have an allergic reaction, the standard course of treatment is Benadryl and steroids. Not me. They have to find another combination. And if I have an RA flare, the common treatment is steroids, usually prednisone. Not me again.

And if I need antibiotics, I am allergic to penicillin and related drugs and other antibiotics interact with some of my other medications. Its not uncommon for a doctor to question me on the reaction I have had to a medication. Or to ask me to alter some of my other medications while on antibiotics. I have sometimes even gotten a phone call from the pharmacy telling me they can't fill my new prescription because of interactions and they need to go back to the doctor for a new one.

Also, the list of medication allergies has ramped up significantly in the last few years. I am nervous about trying new medications because I seem to develop new allergies frequently. Who knew that the anti-inflammatory gel for my arthritic hands and feet would make my heart race?

Finally, without a thyroid, I can't take most medications that have warnings about thyroid disease. Between that and being allergic to Benadryl (which translates to some kinds of antihistamines), treating the common cold is a royal PITA.

The way I see it, they went to school for a really long time and I get to make them think a lot about how they can treat me. I can be a challenge to them so they can't just give me the basics and move on.

I can't decide

No this isn't about cancer. It does say 'breast cancer blog' but my life isn't all about cancer - which is a good thing.

My problem/decision today is - allergies or a cold. I flew back from DC last week and was exposed to all sorts of people. As I blogged on Saturday, I am not feeling that great. But after sitting on my butt for two days instead of getting exercise and not feeling better, I have decided I need to go to plan B. Ignore it.

I can't decide if its a cold or allergies so I am going to ignore it. I have too much to do this week to be sick so I am going to pretend I am not sick. If I get sicker, maybe I'll do something about it. But right now its a stuffy nose, a sore throat and generally feeling blah. And no, please do not recommend Benadryl or other antihistamines because I am allergic. But thanks for the concern.

I am going to work this morning and then the gym, provided I don't turn into a pumpkin in the meantime....

Did chemotherapy change your body?

A week or so ago, I had asked a doctor about change in your body due to chemotherapy. A friend and I had the same discussion yesterday. Does chemotherapy change a person's body in more ways than we think?

I am talking about food and medications to be specific.

Before chemotherapy, I enjoyed all kinds of seafood - preferably cold ocean water seafood to be precise. Shrimp, lobster, clams, oysters, scallops, cod, haddock, hake, salmon, calamari (octopus), and more. I never turned it down. Now I hate shrimp. I won't eat them. I can't stand them.

More importantly are medical allergies. Before chemo, I was told I was allergic to amoxicillin and penicillin (full body rash and hives on an international business trip). I also reacted to the codeine in my pain meds after knee surgery. At my first chemo infusion, I learned I was also allergic to benadryl. Since chemo I have found I am allergic to:

• prednisone - also used to treat RA flare ups as well as allergic reactions
• plaquenil - an old school RA drug
• voltaren gel - anti inflammatory used to treat specific areas of pain and inflammation with RA
• adhesives - as used on pain patches

I was given both prednisone and plaquenil at the same time when first treated for RA. I reacted to both. At the same time. How (not) fun.

And as a result in being allergic to the 'cillins' I have a problem with any potential dental infections. There are four drugs commonly used to treat dental infections. Two are cillins so I can't have them. One is something else that I can't remember what its called (chemobrain) that conflicts with one of my other medications so I can't have it. The last one is super strong and is only used as a last resort. We'll just say I am limited.

If I get a basic cold, I can't take an antihistamine because of the benadryl allergy. Also, I can't take a lot of the others because of the lack of thyroid issue.

I am petrified of concerned about any allergic reactions. They seem to become more and more frequent as time passes. And since I can't be given steroids or benadryl for allergic reactions, there are other drugs which I can take but not the first line treatments. this is one of the reasons I always want to go to the same hospital which has all my medical records. 

But I digress, I think my body changed because of chemo because foods that had appeal no longer do and it seems much more sensitive to medications. My friend also has experienced similar issues. Are we the only ones? I don't think so. And I wish they told  us before chemo that we could expect these changes.

Medications and me

Medications have a tendency not to agree with me. As a child back in the dark ages of the 1960s and 1970s, if I had strep or an ear infection, the local pediatrician would prescribe Penicillin, the miracle drug. At one point, I remember her saying that I had a sensitivity to  it which I promptly ignored because I was a teenager. I don't think my mother remembers that either..

When I was sixteen, I went on a summer program to Madrid, Spain to study at the University of Madrid. We stayed in a university dorm (with a bar on the ground floor, a convent on the first floor, and a dining hall on the second floor which made the world's best paella once a week at minimum). One day I wasn't feeling well, napped all afternoon, attempted to eat dinner but wasn't hungry and went to bed early. I woke up in the middle of the night with a need to use the bathroom and ended up passing out in the hall outside the chaperone's room. The doctor was called, accused me of using drugs (my little bottle of sudafed was deemed suspect) and found I had a temperature of 105. Their modern medine (this was just post-Franco Spain) was shots of penicillin in my behind twice a day. Some how I survived that with no reactions.

(They were very helpful in taking care of me by leaving a nun in my room 24/7 so I was never alone. The nuns only spoke Spanish - I think they wanted to make sure I didn't take any more contraband sudafed. With a temperature of 105 I couldn't speak a word of Spanish if I tried. I was also given everything at room temperature - so as not to shock my body. And each aspirin table needed to be cut into 6 little pieces and swallowed individually with a sip of warm, flat soda so I would not choke. I did get better after a few days and we never figured out what it was. But I digress.)

I never seemed to get strep or ear infections or anything requiring antibiotics for years (maybe I was really a  healthy person once.) Then in the 1990s I had dental infection and was prescribed penicillin which gave me a full body rash and hives. On a business trip... in Europe. I stopped taking the penicillin immediately and called my dentist when I was back in the US. So no more '-cillin' drugs for me.

Around 2001 I managed to ruin a perfect day of skiing with a tiny fall which resulted in a toboggan ride from some very nice ski patrol followed by crutches and knee surgery. A family friend, and former OR nurse, told me to take two of Vicodin that I had been prescribed the night after the surgery to ensure a good night's sleep. I was up all  night. So no more Vicodin or Tylenol 3 for me - we think its the codeine that causes the problem.

Then with chemo, I was given Benadryl to prevent an allergic reaction to the infusion. I was allergic to the Benadryl which means I really can't take any antihistamines ever.

Last Friday, my rheumatologist prescribed me Plaquenil and Prednisone for my RA. I was up all night from the Prednisone and stopped taking it. When I tried it again on Monday morning, I ended up with a bright red face and rash. We decided I should stop the prednisone for now and stick with the Plaquenil. As the week progressed, my rash progressed. It now covers my face, neck, upper chest, around the side of my torso and my arm pit (which is really the pits.) The suspicion is I might be allergic to both.

Our next step is when my rash goes away - in a week or two (according to the doctor) - she will put me on something else for my RA. I hope I am not allergic to that as well.

New Medications Are Not Agreeing With Me

Friday I went to my new doctor, a rhuematologist to start treatment for my newly diagnosed Rheumatoid arthritis (early stage, non erosive). She put me on prednisone (2 tablets daily for 1 week, then 1 tablet daily for six weeks) to start working sooner and Plaquenil (2 tablets daily forever) for long term treatment to stabilize the RA.

I picked up my prescriptions in early afternoon and took both. I knew there was a risk that the prednisone would keep me up at night. It did. I barely slept which means I was a touch cranky and nearly fell asleep at the gym (but get points for getting my lazy butt there). I said no more prednisone until Sunday when I can take one tablet first thing in the morning and hopefully it will have worn off in time for me to go to bed. We slept late so I decided to put that off until Monday morning when upon arising at our normal weekday time I immediately took one prednisone. I did take Plaquenil on Saturday and Sunday.

By the time I took a shower, I decided that I must have gotten a sunburn when we ate lunch outside on Sunday as my face was feeling burnt. Upon closer examination my face was all red and bumpy so I figured some kind of reaction. I got to work and the three women who were there (who are mothers and therefore good a noticing and diagnosing little ailments instantly) said 'why is your face so red?'. Their diagnosis was I had a rash all over my face.

I called my rheumatologist's office immediately and ended up speaking with her nurse practitioner as the doctor doesn't work on Mondays. She thought I was having a reaction to the Plaquenil but I could tell she wanted me to head to an ER if it got worse. I am allergic to Benadryl so I couldn't just take one to help with the symptoms. I did tell her I had an appointment with my back pain doctor that after noon to talk about treatment for my newly diagnosed fibromyalgia and would mention it while I was there.

My pain doctor thought it was a reaction to the prednisone and not the Plaquenil but advised not taking either until I talked to my rheumatologist today. He also did not prescribe anything new for my fibromyalgia other than to increase my pain meds dose. I think he wants to get the RA under control so they can focus on one ailment before going on to the next ailment.

I felt pretty yucky yesterday afternoon and drank tons of water on the theory that I could wash it out of my system. I sat around for a while and then went to the gym which turned out to be a good thing as one of the trainers were there and gave me lots of advice for adapting my exercise program until the RA meds kick in.

Last night I went to bed early, and woke up every couple of hours. My face still feels weird but not as red and blotchy as yesterday. The true test will be when I get to work this morning on what today's verdict is from the mother's I work with.

I don't like these new meds. They are turning my world upside down. Who knew two little brown prescription bottles could change my life so much? I need to find something to work for the RA and then go on to the fibro. This will take months. Grr, grr, grr.

Prescription drug interactions

When I was in chemo, I was told to tell my doctors about everything I was taking - over the counter medications, other prescriptions, and any vitamins and supplements. I thought they wanted to know for two reasons - one to have an idea of the bigger picture of our health and to make sure we were taking vitamins. Then today I found this article that says fish oil can block some chemotherapy drugs.

I know there are lots of potential drug interactions out there. But I think they are often thought of between two different prescription drugs as opposed to interactions with OTC medications, vitamins or supplements. I can tell you from personal experience there are often interactions with everything.  If you aren't sure, take a look at this list of interactions with St John's Wort.

Between my lack of thyroid, allergy to Benadryl, or more correctly some antihistamine in it, and all my other medications, when I get a cold I ask the pharmacist what I can take. They have to think about this for a bit. No aspirin products because I am on anti-inflammatories - this means no ibuprofen, etc. No antihistamines because of my allergies. Nothing that will interfere with my thyroid medication which has all sorts of interactions. Nothing that has any kind of warning 'do not take if you have thyroid problems'. This means if I have a cough, I can only take the basic Robitussin - none of the ones for all day use or with decongestants too. If I have a headache, either I suck it up (and whine) and take a tylenol. Also, with my thyroid medication that I have to take by itself on an empty stomach one hour before eating or four hours after eating or taking any other medications, this gets complicated.

My husband had a cold recently. I woke up and he was rummaging  through the medicine cabinet looking for something. He then went down stairs and moped in front of the TV. When I came down I asked him what was wrong and did he take any cold medicine. The answer was he couldn't find any. Because we don't have any because of my issues. I made a special trip to Walgreens to pick up some heavy duty cold medicines for him. He doesn't have the interactions issues that I do.

When we are traveling I pack our bag of prescriptions and then consider what else to take. Do we need tums? Probably. Do we need tylenol? Maybe. Do we need anything else? I hope not.

And I'm allergic to penicillins and codeine. When I need a prescription, I am a pharmacists nightmare.

Desensitizing to allergens?

There definitely has been an increase in allergens in the world - more toxic chemicals are used more widely than ever before - and more people are showing up allergic. Basically for allergies, we are always told avoidance is the best policy and new chemicals (drugs) are developed to ease the symptoms.

But what if the allergies interfere with the best possible treatment for cancer or another condition? I was told as a child that I was sensitive to penicillin. By sheer luck, I did not receive any for years until in my late 30's, I got a dental infection and was prescribed amoxicillin which resulted in a full body rash and hives (while on a business trip overseas - how fun. NOT!)

Later while in chemo, I discovered an allergy to benadryl (yes the stuff they give you for allergic reactions). During chemo, the protocol is to give you some combination of an anti nausea drug, a steroid to reduce reactions, and sometimes an anti-allergy medication (Benadryl in this case) to reduce reactions to the very strong chemo drugs. Well, I had a reaction for about 30 minutes and was told never to take Benadryl again. But I was not allergic to any of the chemo drugs.

But what if a patient is allergic to the best possible treatment for their illness? What then? Do you suffer through the allergic reactions (and hope you are okay) or do you go to a potentially less effective treatment? Well the new theory is densensitization of patients to drugs so they can get the best possible treatments.

Through my cancer treatment, I always wanted the option with the best possible numbers associated with it. If I was allergic to one of the drugs, I think I would want to try this new option to have the best possible odds. Consider it the same as driving an extra hour to get to the best hospital. Why not?