Continuing work during chemo?

Hello! I just sent you a very long private message that provides a lot of details. As a teacher, you raise good points, and you'll be able to interpret more about my specific situation. Thanks in advance for taking the time to look at it and respond (if you so choose)!

Hi, NCteacher!
This post is from AnnWood, fellow teacher, again (We posted back and forth a few times a few months ago).

I am very impressed with the patients who continued to work!

I feel like I'm going to rain on your parade, but I do have some observations to protect yourself professionally.
Will taking the part time position affect your insurance? Your seniority? Your pension?
If you have a union representative or a human resources person, maybe you should talk to him/her about it.

If you stay working and have substitute teachers: Will you have more work- leaving plans for the sub? Mopping up after a sub doesn't complete your plan? Are your parents the type who will complain about so many subs? All of these things happened to me when I was on short-term disability. My principal actually told me about the parent complaints when I was still recuperating!

The disability rules can be convoluted. My HR lady warned me that, if I returned to work and then found that I needed to stop working, then according to the rules, I wouldn't be eligible for disability pay for the original diagnosis.

While it may be good for your mental health to continue working in some way, it might be wrong for you financially and professionally. I'm really sorry to have to mention all of these negatives...

Keep us posted. Good luck and peace to you.

I meant to add, I have taken my corporate laptop to a chemo infusion twice and attempted to login and work remotely from the recliner, but that didn't pan out at all. Sometimes you just have to say no!!! 🙂

You are amazing!

@k13 , When I looked at my lab results, I spotted a note that the CA19-9 value could be artificially low if the patient was taking a very high dose of biotin (Vitamin B7). B7 was one element of a whole B-complex tablet I was taking, so I've temporarily stopped the whole thing while shopping for individual B's without B7 and lower doses of the others.

My treatment center's pharmacy specialist pointed out the data she had for the effect of B7 on her lab's CA19-9 test, but not knowing the real clearance rate from my body, I've opted to be conservative (no B7 during chemo) until we get a better idea where my CA19-9 is really going. I'm in kind of a hurry to resume the rest (esp. B12) with the hope it helps my neuropathy.

Her other main points were that antioxidants can reduce the effectiveness of cisplatin and increase the risk of bleeding on Abraxane, and also that enzymes that help break down and clear it from your system can be inhibited by certain supplements. Her full response is pasted at bottom.

My oncology PA told me about the phone app "About Herbs" and related website from MSKCC that has good info about interactions of various supplements: https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs/about-herbs

---- Response from pharmacy (Note: My chemo is now gemcitabine + cisplatin + Abraxane)

Your first question related to the interference between biotin (Vitamin B7) and the CA 19-9 results. Impacts on these results are seen with doses of biotin greater than 5 mg taken within 12 hours of the test. Every milligram (mg) is equal to 1000 micrograms (mcg).

For interactions between the extensive supplement list and your chemotherapy, B vitamin components (includes pyroxidine (B6), thiamin (B1), riboflavin (B2), folate (B9), niacin (B3), pantothenic acid (B5)and biotin (B7) are OK. In general, any vitamins or minerals listed a 100% or less of daily recommended requirements are OK.

Avoid any component listed as an antioxidant - this has the potential of reducing the efficacy of cisplatin. These include high levels of Vitamin E, Vitamin C, coenzyme Q, tumeric, and many others. In addition many of these components can add to any bleeding risk, and should be held if your platelets are low (good possibility for any one on gemcitabine, cisplatin and Abraxane).

An additional concern is interaction with enzymes that break down chemotherapy. This does not apply to cisplatin or gemcitabine, but does affect Abraxane. Abraxane is broken down and eliminated from the body with the activity of enzymes 2C8 and 3A4. Quercitin for example inhibits the activity of both these enzymes and could lead to a buildup of the drug (and higher side effects) in your body.

I would recommend holding supplement containing any of these components at levels greater than 100% while receiving gemcitabine, cisplatin, Abraxane.

---- End of pasted message

Hope this helps!

mmfl

Thanks for that info. My husband has also continued to work. I think it’s a good distraction for him. He feels productive and gets strength from all his coworkers supporting him. May I ask which vitamins and herbs you discontinued? And was it your on oncologist who suggested stopping those?

I worked through the 24 months of chemo of alternating cycles of Folfirinox and 5-FU/Leucovorin given in groups of six. This occurred from age 55-57. Chemo was in NYC across the street from my research lab at a large medical center that required a daily 2’20” commute by train, subway and a final 4 block walk or bus ride. I went back to work full-time 8 weeks after my 9 hour Whipple procedure. My day started at 5:00 am to make a 6:15 am train and I arrived back home at 7:15 pm to prepare dinner, clean up, do a short walk in nice weather and try to get to bed by 10:30pm.

Weekends was errands, yard work and house cleaning. The Saturday of chemo week when I finished the yard work, the fatigue hit in the evening. I crawled into bed and slept till early Sunday afternoon and that restored the energy level and was fine the second week. During and following chemo the first week, I was given dexamethasone which gave me so much energy I could not sleep Wednesday through Friday night. I worked under the department of pathology and the Chief of Pathology did not expect me to return to work. He was very familiar with my medical case of quickly being restaged to IV a week after my Whipple. He instructed my immediate supervisor to hire my replacement. I was happy to be back at work with great colleagues and wasn’t going to be “put out to pasture”. I was determined to show everyone I was not giving in.

Working in a clinical research lab made it difficult to eat small meals frequently. At lunch time is when I tried to take a short nap. I was never prescribed a pancrealipase after my Whipple. That sometimes resulted in intense abdominal cramping and sudden urgency for a toilet. I was consistently on anti-diarrheals like Lomatil and diphenoxylate atropine taken prophylactically to get me through the daily work week. It was no guarantee and a daily round trip of 4’30” on public transportation was challenging. I survived it and for me, going to work and being with colleagues gave me normality and structure in my life, I survived a grueling commute, full work days and 11 years after being treated for stage IV disease.

Definitely do not stop working if your job can be flexible. It’s important to have more on your mind than yourself.
And-you will be amazed at the people God will put in your life that may help you or you are given the opportunity to help.
I did the wed-Fri infusion then snapped back ok by monday. Often by Sunday. You can do it! And I bet you are younger than me!!

Hi NC teacher
Working is good for the mind and soul. Give it a try. My cousin Maryann is working through two years of treatment. First she was taking Abraxane/Gemcitabine for 17 months. Now she is taking 5FU. She has a very supportive boss however she is working full time too. Maryann says that the job helps her not think too much about the cancer. She is involved with work and likes to interact with the people. During the week when she does have chemo she does need to take off 1 or 2 days
If your principal can be understanding with your treatment you can get a substitute in for a day or two if you are not feeling well. My cousin had chemo every other week. This month in June it will be 2 years and she looks amazing and feels good. I hope you also feel well and remember to be positive You are a teacher so you must be a caring positive person
Sincerely Susan

I worked during my 6 months of Folfirinox (age 58-59), then took 6 weeks of leave after the Whipple, went back half time for a month, then full time again. After recurrence and new chemo, I'm still working full-time, except for the chemo days.

I was getting the biweekly Folfirinox at a center close to home, but since Day 1 was all day, that was a full day off work every time. Since that regimen included 46 more hours with the take-home pump, the next two days had to be work from home. I would generally make Day 1 a Wednesday, so Thu/Fri were at home, recover over the weekend, and resume work (mix of at-home and in-office) on Monday.

With the new regimen (biweekly Abraxane + Gemcitabine + Cisplatin), it's all done in one day, but I chose to do it at a center 2.5 hours away, so there's 5 hours of driving on top of 5 hours of chemo. I generally do those on a Friday, recover on the weekend, and work from home Monday if possible. I'm wiped out every other Saturday, and my ninth treatment last week really knocked me for a loop all week. I found out some of the vitamins and herbs I was taking were not recommended during my chemo, and stopping those may have contributed to the fatigue.

None of it has been easy. My boss understands that midday naps are sometimes necessary, and I'm consuming a lot more caffeine than I should to get through each day. I still walk 2 miles every night and then cool off with a shower before bed to help get the caffeine out of my system.