My post this morning was a little rushed, so I missed a few interesting details. The big question for everyone was why is this happening on my hands and not anywhere else. Most people who have this complication see it on hands and feet or hands/feet/mouth. Several doctors were looking for other locations for the sores, and not seeing any.
It was the on-call dermatologist (happens to specialize in chemo related derm complications so I picked a good night to be in the ER with this issue) that made a comment about ‘motor biking’, that had me saying – on Friday morning I went for a nice long (1hr+) bike ride on my folding bike. The blisters started about two hours after the bike ride. Of my three bikes, this is the one with mountain-bike style handle bars. And that is when the ah-ha moment came. The bumping associated with riding (I do wear gloves but still) didn’t align well with day chemo+4. There is a range in the chemo cycle where I’m more susceptible to this type of thing happening, and any trauma can set it off. The places on my hands where the blisters are align with sweat glands – and trauma to that area when my body is expelling chemo drugs can cause this toxicity effect (at least that is what I currently understand).
She asked if I had been warned about this complication – not that I can think of. That being said, many of the warning have been overly cautious and lacking details. Telling me not to ride or swim is useless, but telling me that I shouldn’t ride an upright bike on days 4-8 is a lot more useful (I now know this is when the chemo is leaving your system, so toxicity effects are most likely) and telling me I shouldn’t swim days 8-12 is also useful (this is when blood counts are low). The overly cautious recommendations would have me sitting on the couch watching TV the entire time – which is actually contra-indicated – exercise has been shown to improve chemo effectiveness as well as decrease side effects. So, I am looking forward to a discussion with the dermatologist on Tuesday where we can actually go through the best times and worst times for specific activities in order to reduce the likelihood of a re-occurrence in the next cycle. I’m also kinda happy that I’m presenting an interesting case for at least one of the doctors at Stanford 😉