Issues with mild anemia and motion sickness type symptoms

Zytiga (abiraterone acetate) can cause dizziness. This lightheadedness is often linked to underlying side effects like high blood pressure, heart rhythm changes, low potassium, or adrenal insufficiency. Have you been checking Your blood pressure regularly. I do it every day, Since abiraterone gave me high blood pressure five years ago.

Some people get serious fatigue due to Zytiga. I was working with one guy who would get up in the morning and be so tired he had to go back to sleep for three hours. I told him to ask his doctor to increase his prednisone to 10 mg. The doctor did that, and his fatigue was greatly reduced.

At one conference, I watched online, a doctor talked about his situation with Zytiga. He had a lot of fatigue so he increased his prednisone to 7 1/2 mg. That helped a lot, but after a little while, he found out it caused him to become pre-diabetic so he had to cut back down.

I am telling you about both of these stories so you realize that more prednisone can make a difference, but you have to be aware that you have to get your blood sugar tested, An A1c test would do it every three months.

Some things to talk to your doctor about.

ADT is known to cause anemia. My levels went from mid normal to just below normal range on Hemocrit, Hemoglobin, and red blood cells. Slowly recovered after ADT ended. Probably related to low testosterone.

Prednisone is known to cause insulin resistance the key driver of type 2 diabetes. This can result in prediabetes or even diabetes if you are already prediabetic. Going without the prednisone while on Zytiga is worse. If at risk see if you can get a 2ed gen ARSI (Nubeqa, Erleada, Xtandi) to replace it. You might need this due to the dizziness.

I experienced mild anemia after my radiation therapy in 2021 (middle spine) and 2022 (prostate). I was also on ADT + Apalutamide at the time.

The anemia resolved itself after 2-3 years, and I'm back in normal range now. I'm still on ADT + Apalutamide, so I'm more inclined to blame the radiation or the spinal surgery that preceded it.

Fingers crossed that it resolves for you, too.

As for the light-headedness, that's a non-specific symptom that can come from all kinds of different causes, including (but not limited to) your meds, so it might take a bit of trial and error to track it down. Does getting more active help?

There are a wide variety of causes for vestibular disorders, including the drugs you are taking. However, 5-10 extreme episodes a day is very concerning and I wouldn't just automatically blame the drugs. It could be caused by something as simple as Benign Paroxysmal Positional Vertigo, easily remedied by a vestibular therapist, or as serious as a central nervous system disorder. By all means talk to your cancer care team, but I would also ask for a referral to a neurologist who specializes in vestibular disorders to rule out anything other than your present drug regiment. I've had severe vertigo in the past, not nearly as frequent as what you are describing but I understand the feeling. Mine was not caused by any meds I was taking, but did respond to 2 months of vestibular rehab.

@northoftheborder

I don't know if exercise would help I'm not really into the gym scene. I live on a hobby farm so I stay active. When Im doing farm stuff I'm moving alot and it actually aggregates the dizziness.

@cherylwi The farm is good for exercise — I wasn't talking about becoming a gym rat necessarily 😉 — and your experience makes me agree (as a layperson) that it's not just low energy or brain fog from your meds, but some kind of vestibular disorder.

@cherylwi, physical activity counts. Exercise is not only to be found in the gym. When working around the farm and yard, you might think about balancing out your movements. For exaample, when using a rake or a shovel, alternate between your dominant side and your non-dominant side, 5 strokes a side.

Have you talked with your doctor about the dizziness factor? They might suggest vestibular physical therapy. Vestibular PT is a specialized treatment designed to resolve or manage dizziness, vertigo, and balance issues. There may be more going on.

I have spoken to both my primary and oncology doctors. They are recommending some slight medication changes. Frankly this side affect while being quite annoying is not impactful enough for me to seek any changes online my cancer treatment path. I'll just have to power through these next 8 or so months

I'm a heart failure patient with mCRPC. My cardiologist expressly vetoed Lupron and Abiraterone when I was first diagnosed due to their propensity to cause heart rhythm issues. The meds I ended up on (Orgovyx/Nubeqa) while more cardiac friendly, still required a minor tweak to my heart meds to calm the rhythm down and kick up blood pressure a little. Even so, I squat, instead of bend, to pick things up so I don't get dizzy. Has a cardiology visit been suggested regarding the dizziness or, at least, an EKG been done to check rhythms?