Episode 15: The Bitter Truth
Most of us know that cancer patients go bald. But do we understand why? And what do we know about the host of other side effects cancer patients endure? On today’s episode, the sisters get sciency and help us understand the side effects of chemotherapy, radiation, transplant, and surgery.
SHOW NOTES
Sources and Further Reading:
Children with Hair Loss nationwide organization based in Michigan
Mayo Clinic articles on the following treatment types:
The phrase “have the best week available to you” comes from the wonderful podcast Pantsuit Politics
TRANSCRIPT
Kayla 0:09
You're listening to the My Sister’s Cancer podcast. I'm Kayla Crum, registered nurse and writer.
Ella 0:15
And I'm Ella Beckett, social worker and cancer survivor.
Kayla 0:20
We're sisters on a mission to care for the cancer community through the sharing of real life stories, a sprinkle of sass, and lots of support.
Ella 0:28
Join us in a new kind of pity party. It's a pity so many of us carry the heavy burden of cancer alone. So let's make it a party and carry it together.
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Kayla 0:42
Hello and welcome to the My Sister's Cancer podcast. I'm Kayla Crum, one of your co-hosts, here as always with my wonderful sister Ella Beckett. Today we are starting our second episode of what we're calling the treatment season that coincides with fall, if you're listening in real time. And today our topic is side effects. But before we jump into that, I just wanted to do a couple of housekeeping reminders. First of all, we have an Instagram at My Sister's Cancer. We love to hear from people on there. Feel free to drop a comment. There's a post for every episode. We also have a website that has a page for every episode, and on there you will see show notes. So that's links to anything we might mention during the show, further reading and resources, other people and podcasts we recommend you follow in the cancer space. Lots of goodies on each podcast page at our website, mysisterscancer.co. We also have a Patreon. So for those of you unfamiliar, that is a website that allows listeners to support podcast creators, or really I think it's for any type of creator. But for $5 a month you can support our work and the time and money that goes into making this show. And hopefully we will be able to provide some bonus content in the future for that private community as it grows. Maybe some stuff that we wouldn't want to put on the actual Internet for everyone to hear, but maybe going a little deeper into some of these issues or taking questions. So we're not sure what that space is going to look like yet, but we're slowly getting a few patrons and wanted to invite you to join us. The last thing I wanted to mention is that we also have an actual mailing address. So you might have seen it if you get our email newsletter or on the website, but we do have a PO Box. PO Box 407 in Grand Haven, Michigan, and we got our first piece of snail mail from a listener, and that was just so delightful. I was so pleasantly surprised to see a handwritten note from a listener. So thank you, you know who you are, and I just wanted to let everybody know that in case anyone else feels so inclined to send a note, maybe something that you don't want to send on an Instagram message or something, and it feels a little more personal, we're always happy to receive your communication any way you feel comfortable. So now that all of that is out of the way, Ella, why don't you give us a little overview of where we're going to go today?
Ella 3:20
Of course. So, as you mentioned, our topic today is side effects, and I think a great place to start is that a lot of us, when we think of cancer - I mean, I know this was me before I myself experienced it. I think we all think of what I like to call “movie cancer,” where the patient is just, like, strapped up to an IV that's dripping into them for chemotherapy, and they're often bald. You often see them depicted as getting sick frequently, and those were kind of the things that I thought of when I thought of cancer and its side effects. But I don't know that a lot of us have a great understanding of why cancer patients are bald or why chemotherapy makes patients sick. I know I for sure did not before I myself went through it. So this is going to be a little bit more of a sciency episode, but we're also going to tie in, of course, just some personal experience with my story and just some different things that I experienced specifically in my treatment. But we're just going to kind of talk through chemo, radiation, transplant, and also surgery, although I really didn't have any major surgeries throughout my cancer treatment, but we know that's true for a lot of people who are experiencing cancer, and so we just wanted to touch on that as well. So, Kayla, did you want to first guide us through a little bit of the background science of chemotherapy?
Kayla 5:06
Sure. I think we might have touched on this way long ago in an early episode, but chemotherapy is a broad category - there's hundreds of drugs that fall under this title - for drugs that target fast growing cells in your body. It's sort of like our first thing we think of when we think of cancer treatment. And like you mentioned earlier, people often picture it as an IV. That is very common. It can also be taken orally, depending on the kind of drug, sometimes even like a patch. There's a variety of ways you can get them delivered. Some of them are into your veins, some of them are under your skin, like subcutaneous. So there's lots of different ways you can receive it. Like I said, it targets the fast growing cells because cancer is one of your own cells growing super fast, and unfortunately, it's not super specific. So that's actually why people lose their hair, because hair, and actually your nails, too, are some of your fast growing cells. So people don't usually have their nails fall off, but they often will not grow as quickly when you're on chemotherapy. We also think just of people's hair on their heads, but it's hair over your whole body. So you kind of become completely hairless with most of the chemo drugs, some of them not, especially if you're just on oral drugs. Some of them don't have that side effect, but I would say the majority do have that hairless side effect. Um, another fast-growing cell area is your mouth. And basically your digestive system from mouth all the way to the other end. So I think we all know, but kind of forget from science class that it's all one big connected tunnel, basically from your mouth to your stomach to the toilet. And all of those cells on the inside of you are very quickly growing because they're like working hard, digesting food and constantly getting sloughed off, to use a weird medical term. And so that's why people have terrible mouth sores with some chemotherapy and also the nausea that we often think of when we think of cancer patients. Unfortunately, puking a lot. For some reason they always depict the puking in movies. You don't really ever see the other end, but that is also a problem for people. Weirdly it can be both too much and not enough when it comes to bowel issues. But that's kind of a broad overview of chemo. Each one has its own little list of terrible things that could happen to you. Unfortunately, some of them cause, like, rashes and sun sensitivity. That's kind of the main points. But like I said, most of them do have their own little quirks as well. So, Ella, as much as you're comfortable sharing, would you talk us through a little bit of your experience with chemo? Because your treatment was, I would say, majority chemotherapy for your Hodgkin's lymphoma.
Ella 08:15
Yeah, and I would say that my cancer and my treatment and chemo and everything was very similar to what the movies depict. I did experience a lot of nausea and vomiting, and that's just miserable. I mean, it - it just made me very sick, like all of the time. And I think one thing I do want to say is I think that everyone is really different, like we've said many times before on this podcast and will continue to say, every single person's experience is so different. And so not everyone even experiences nausea or vomiting. It's - they could have the same drug and just not respond in the same way. Unfortunately, I did experience a lot of that. When you mentioned mouth sores, I remember my very first round of chemo was inpatient and one of the worst parts of that specific round was that I developed really terrible mouth sores to the point where I just could barely eat anything. And I remember getting home and you're finally home from the hospital, right? One of the first things you want to do is eat home food, home-cooked food. And I just could not even really eat anything because the entire inside of my mouth was just like open sores. And then when I was able to eat, it was just like my stomach was so sick and I just wasn't able to keep a lot down. Now, thankfully, it came in waves. I wasn't sick all the time. But the way that chemo kind of works is that, at least in my experience, shortly after you get it is when you're very sick, and then you kind of build back your strength for a few weeks and then you have to go back in and get it all over again. So it's a really difficult thing because you finally are starting to feel a little bit better, you're able to eat food again, and then you go in and get all the same drugs that made you so sick. So I found that to be a really difficult part of treatment; was just like the cycle of it where you would finally be feeling more yourself again and then just you’re on the couch super sick again. One other thing I think that I definitely want to speak to is just the hair loss piece. I think specifically for women, and I think any woman, but I think, especially being a young woman, my hair was just such a part of my identity that, honestly, that was one of the hardest parts for me to cope with, was having to lose all of my hair. And I'm glad that you mentioned, too, the fact that it's all of your hair, because I was really fortunate enough to have a wig that was completely no cost to me through an amazing organization called Children With Hair Loss. And I felt very confident in my wig. I loved my wig, and so I really wore my wig out all of the time. I really wasn't seen by hardly anyone without my wig. But one of the hardest parts for me was having to lose my eyebrows and my eyelashes, because that's such a defining feature of your face. I don't think you even think about how much your eyebrows and your eyelashes, how much they define what your face looks like. But having to lose those was really difficult for me, too.
Kayla 12:05
Yeah, I can't imagine losing all your hair. I remember we had a great ballet teacher who also had - actually, I think it was Hodgkin's Lymphoma. It might have been non-Hodgkins. She used to say, “You know I never had to shave my legs,” and I just was like, oh. I think that was maybe the first place I learned that, oh, it's like your whole body. I just had never thought about it. But something else that I think gets misconstrued from the movies is weight gain or loss. So I think you typically picture a cancer patient as, like, skeletal from the movies, and that can definitely be the case. You lost a significant amount of weight, but something that is often given alongside of chemotherapy is steroids, orally or via IV or your port or whatever. And that can be to decrease inflammation and, like, just help with other aspects of your body coping with the chemotherapy. And that can actually make people gain weight. So we just wanted to say that that's also something that can go either way. Right. We're always saying everyone's story is different, and you can't just assume anything based on how somebody looks. Like Ella out in her wig, just looking like this thin, young, healthy person. I think most people who just met you on the street would never have guessed that you were going through cancer.
Ella 13:38
Yeah.
Kayla 13:39
Um, but I also wondered if you would tell our listeners a little bit about chemo brain.
Ella 13:43
Yeah, so that's a term that you might have heard tossed around a bit. And really what it is is just overall brain fog that can come as a result of chemo. And this is something that I really experienced. I mean, one thing I didn't mention earlier that is definitely a large side effect for most people, I think, with chemotherapy is overall fatigue. And I think that kind of coincides with the chemo brain piece of it. I really experienced this the most when after treatment, I jumped right back into college. And I just remember a few months before that, right, I had been in high school, and granted, my high school classes were probably not as difficult as my college classes, but I just remember so many times where I just felt so foggy, like I wasn't able to focus on anything. It was really difficult for me to write papers, and writing used to come so naturally to me. And I think it was just like I was still so fatigued as well. And I think I just really struggled kind of breaking through that fog for quite a few months, I would say after. And that's something I wanted to point out, too, is that we're kind of focusing on the side effects that you experience kind of when you're in the thick of chemotherapy, but there really are a lot of effects that come afterward that can kind of linger. And one of the things that I experienced really during and after my maintenance phase of treatment was that I had a lot of neuropathy. In my hands a little bit during treatment, but then one of the drugs that I had really caused me to have a lot of difficulty walking even. I struggled with my feet feeling numb and just an overall lack of strength in my feet. And really, that was something that I experienced months after the main portion of my cancer treatment. So there's a lot of different things that can kind of come up months and years later as well.
Kayla 16:12
Yeah, thanks for mentioning that. I think that although this isn't necessarily a direct side effect, loss of strength and, like, muscle wasting is another one. When you're inpatient, they try to have the physical therapist come around and make you do stuff, but nobody feels like it because they feel terrible. And you spend a lot of time sitting around when you have cancer hooked up to machines. And so it can take people years to build back the strength they had, or it might never quite be the same. You experienced numbness in your feet. Some people, the chemo drugs they're on can give you weakness even in your hands or hearing loss. There's a wide variety of things that are lesser known that a lot of patients deal with for years and sometimes the rest of their life. Like, your feet got better. But I would say it took years of slow, slow improvement and physical therapy.
Ella 17:09
They're still not what they were. Yeah, they vastly improved from a few years ago when I was tripping and having trouble walking more than 500 feet, but unfortunately yeah, I still have some issues with them at times.
Kayla 17:28
As your sister, I won't ever forget, like, we were out with some cousins, and you were tripping a lot in your high heeled shoes, and you were supposed to be better, and we were out doing this fun girly night, but you had a really hard time. And we were dancers. We did ballet. Walking in heels was not a problem for us. And I think that was, like, the first night it kind of hit me, and I feel like maybe you, too. It was pretty early on, and you were like, my feet are not okay. And then it just got worse, and eventually you sold them online, because, unfortunately, we're not the same shoe size. And I just - yeah, it's all those little losses that cancer sometimes takes from you that just aren't depicted in the movies that I think are sometimes quietly grieved and nobody really realizes. We'd love to hear from the listeners if that reflected your experience or if you have something to add to the conversation around chemotherapy. It's a super diverse field of different medicines. So, like we always say, her experience is not everyone's experience, but we just thought we'd provide a little community education and do a little better job than the movies for people understanding what it's like to have cancer. So the next type of treatment that you most often hear after chemo, I think most people are familiar with the term radiation. This is like high powered X-ray, for lack of a better term, that targets the cells in your body at a really high frequency to kill off the cancer cells. I'm a lot hazier on the science of radiation because the people that run those machines and plan the way it's all done are super geniuses. Like, I swear they could be like rocket scientists. They have all these degrees and are super smart but it is some sort of, like, laying in the machine and this high power like radiation beam comes at your body for minutes at a time. And you often have it like every day instead of chemo being like maybe two or three days and then a three week break, or once a week. Radiation is often like every weekday for two months or something like that. Just the way that it needs to be done. So something that I thought was interesting when you got radiation, Ella, was your tattoos. Do you want to share about that?
Ella 20:03
Yeah. So I always say that I don't have any tattoos, but I guess that's not even true because they gave me these little tiny - they're basically just little dots that are like actual tattoos. Like they put ink in my body, basically, to mark where the center point was, and then the sides, so that they could line me up properly, which I'm like, I had no idea that that was a thing. And I just remember when they first told me that they were going to do that, I was like, what? I did not expect my first tattoo to be these silly little dots on my sternum.
Kayla 20:48
It's like a freckle, almost like smaller than a freckle, but you can still see them.
Ella 20:53
Yeah. And I think basically they just used it to make sure that I was lined up properly. That's my understanding, at least.
Kayla 21:03
Correct me if I'm wrong. You basically have to lay super still on this table and they sort of lower the machine over you. Kind of like if anyone's had a CT or an MRI. But, I mean, how would you compare it to a scan of that sort? Like, what sticks out as different in your mind? Because I think radiation is something people don't have a good understanding of what it's like.
Ella 21:23
Yeah, I mean, I've heard people say that sometimes you can smell the radiation, like the beams or whatever. I don't really think… that doesn't stick out to me as something that I remember. One thing I do remember is that it was so quick. So, like Kayla was saying, you're there every single weekday, five days a week, for yeah, I think it was like eight weeks or something like that. But we had to drive 45 to 50 minutes to get there every day. And then you're literally in there for like five to six minutes, tops. Obviously, you have to change into the hospital gown and whatever, but the actual radiation is just like a few minutes, which is super weird. But again, I think it's just they're limiting your exposure whenever they can, but targeting it in such a way that it's effective, but not putting you at risk for too many other things, because - I don't think we've touched on this yet, but exposure to radiation therapy can put you at risk for future cancers as well.
Kayla 22:37
Yeah, that's one of the double-edged swords, like, hey, we're going to cure you, but we might give you another cancer while we do it. It's kind of a weird thing to think about. So it's very dependent on where on your body they're doing the radiation. So people who get radiation targeted toward their chest might be at risk for breast cancer, or people targeted… you know, say they had, like, colon cancer, then because your colon can be kind of next to your liver and stuff, like, maybe we'll accidentally give you liver cancer. And obviously, like I said before, these people are super smart. They're constantly making these mathematical high power calculations to see the maximum benefit versus the minimum risk and all of this stuff, but it's just their best educated guess at the end of the day. And I also just want to say that your side effects really depend on what area is being - it's actually called irradiated. That's the verb. What area of you is being irradiated. So, like, I remember, Ella, yours was kind of up by your neck and chest area, if I'm correct. And they were like, you might have trouble swallowing, you might have throat stuff, and you never really experienced that, and maybe that was just due to the amount, but what did you experience?
Ella 24:02
I vaguely remember them talking about that and potential for heartburn, things like that, but things don't really stand out to me in my memory. And honestly, that could be the chemo brain, like I was mentioning earlier, that lingered for a while. Some of the details are very foggy in this whole season of my life. But I do remember they talked about the radiation treatment kind of builds and builds and builds, and then the main side effect for me was just fatigue. And that can kind of just linger for a few weeks. So it's like the more radiation you get, the more fatigued you're going to be, and then it just kind of stays in your system, so to speak, for a while. And I think that was the main thing that I experienced was just, I was very tired all the time. But this was also the period of time after my transplant when I was on in-home isolation. So I really couldn't go anywhere or do anything. So it was okay that my main job was just to rest during this time.
Kayla 25:15
Yeah. That actually leads us to our next topic, which is transplant. So when we say transplant, that can mean a lot of different things. In Ella's case, she had an autologous stem cell transplant, which means her cancer was in her blood. It was Hodgkin's lymphoma, but it had not infiltrated her bone marrow. So they were able to harvest brand new baby stem cells that had no cancer in them from her bone marrow and give her her own cells back. So I remember a lot of people were confused when we were like, she's having a transplant. And they were like, who's the donor? And we were like, she is. That's confusing. People are like, why would she want her own cells? But it's because they're in that safe little bone marrow cavity or whatever you want to call it. And they're like brand new stem cells that haven't gotten exposed to the cancer yet. Now, people who do have their cancer progressed into their bone marrow do need an external donor who matches a variety, not just your blood type, but a variety of different - I think they call them HLA factors to get a good blood cancer donor. That's all just for blood cancers, leukemia, lymphoma. There are people who have different kinds of cancer where they need other transplants. But I would imagine there are types of organs that can be transplanted for cancer patients. But a lot of times when you hear transplant in the context of cancer, it is a bone marrow transplant, also called a stem cell transplant. So that was Ella's experience. And what they do is they basically are giving you a whole new immune system. So first they have to get rid of the old one, which means giving you so much chemotherapy that you literally have no immune system left, and then infusing you with the new cells, whether they're from your own bone marrow or a donor’s. And it's just kind of crazy because it's like all the chemo you had before was like little league, and this is like the professional league. We are going to give you the big guns, like all the chemo, to completely flatten your body's ability to fight infection and make new blood cells because we don't want that right now. We're going to give you the cells. So it's kind of bizarre. Some people go as far as to say they bring you to the edge of death and back. And that doesn't mean she was lying there unconscious, but she was in very strict isolation because she had her immune system stripped away, and then they infuse those new cells. So one of the weirdest parts is that then you have the immune system of a newborn baby. So she needed all of her childhood vaccinations over again.
Ella 28:06
That was a treat.
Kayla 28:07
All the little, the Tdap and all of this stuff that you get at your kindergarten visit to the doctor and your twelve-year-old; you know there's different stages in childhood. Ella had to get all those again, and then all the colds you caught as a child don't matter anymore. You have to build up that immunity again. So that's again, sort of a delayed side effect. Like we're focusing more on actually in the moment stuff. Right. But she would get sick a lot even after she was, quote, better from cancer because she had this little kid immune system. So Ella, do you want to tell us a little bit about the difference between the big chemo versus the little chemo? And I hate to say it that way because I don't want to minimize anyone's experience with chemo. Chemo is terrible no matter what you get or how big the dose is. I'm not trying to minimize that. I just remember being kind of like, shocked when I was like, wait, you're saying that was like, you held back and now we're doing more? It's just crazy.
Ella 29:09
I mean, I think what you were saying about pulling out the big guns, that's exactly how it felt. I think some of it, too, is the timing of it and how it was so condensed. Like, for my other treatment, like you were saying, it was kind of… I was on like, a cyclic chemo schedule where, yeah, I would go in and get chemo for like, a few days maybe. And then I'd have a few weeks off and my immune system would recover. My blood counts would come back up, and then I would go back for more. But this was, like, all at once, and it was like, this certain combination of basically the strongest stuff available to them to basically wipe out my immune system, as you were saying. And… I mean yeah, I think arguably that's the sickest I've ever been… and just the weakest and most tired. I mean, I just remember, yeah, they wiped out my immune system, but it just wiped me out. Like what you were saying about the PT coming by. I remember clearly, like as I'm inpatient for my transplant, they were trying to keep me active, keep me moving, keep me strong. And it's like I had all I could do to get my body up and even walk to the restroom. There were certain points in my stay where I was so sick that I had to have a little bedside portable toilet because I couldn't haul myself up and walk with my IV pole to the bathroom. That just kind of gives you an idea of how sick I was and how weak I was. I mean, I think I was inpatient really only for like a week and a half before the actual transplant. So again, it was just so much all at once.
Kayla 31:14
Yeah, I do want to clarify that you still had that cyclic chemo and stuff for months to get your cancer suppressed to a certain point before they admitted you and then slammed you with all this chemo. So it wasn't like when it returned, they just admitted you and did all this intense chemo. It was like they did some more of what you had before, the more traditional cyclic regimens, and then once you got to a certain point, then they kind of slammed you with all the harder, bigger stuff. I also think that one thing I want to touch on that you don't have to deal with, but that a lot of people do, is GvHD, which is graft versus host disease. So if someone has donor cells for their transplant, they might experience this. It's called engraftment when the new cells they give you engraft into your blood; basically, they're like, yes, okay, we're going to multiply here. We want to stay here and start to multiply. So if they're donor cells, even if they did their best to find the best match available, sometimes your body's like, I don't think this belongs here, and can attack itself. And so some people who have had a donor transplant are on medications their entire life to suppress their immune system because their immune system is constantly trying to fight the donor cells. So it's weird because it gives you your life back, and yet your body is still like something's not familiar here. So that can manifest in all kinds of different ways bad skin rashes, joint and bone problems, ongoing illnesses. So that's something that a lot of people deal with. Again, that's more of an after effect. But when we're talking about transplant, that's a huge side effect I just wanted to highlight. Finally, we're going to talk about surgery. Like Ella mentioned at the beginning, she did not have a major surgery addressing her cancer because her cancer was a blood cancer. But she did have two or three different ports put in over the course of her cancer. A port is an implanted device in your chest that can have a special kind of needle put into it that allows drugs to go basically right into your heart quicker. It's called a central line, instead of like those little IVs in your wrist that you see in the TV shows. Those do work, but when you're getting these high level drugs, a lot of them have to go into a central line because these little veins or whatever in our arms can't handle it. So she did have a couple of ports put in and taken out, and then biopsies. That's a huge part of a lot of people with cancer. A biopsy is one of your diagnostic steps, and sometimes along the way and down the road, you have more biopsies. So, like for Ella, she had lumps in her neck that they biopsied the lymph nodes. You know, if you have cancer anywhere else, like, they can take a biopsy, a lung biopsy, a scope to do a bowel biopsy. A brain biopsy is a thing. So I just wondered, Ella, if you want to touch a little bit on your experience with the somewhat minor, but I'm sure still difficult procedures you had done.
Ella 34:37
Yeah. Up until this point, I mean, the only thing that I really had been put under for, to my knowledge, was when I had my tonsils out in the second grade. So I think anytime that you're being put under, I feel like it's just kind of scary and it's kind of unknown. Right. You're like, okay, I don't really know what's going to happen. And I don't know, there’s always just kind of fear surrounding that and some anxiety. So I remember even for my initial biopsy, it was just kind of scary to be put under and not really know what was going to happen while you're out and all that good stuff. But thankfully, because I was in the children's hospital and in that world, rather than quote, adult world, I do think they put me under for things that they wouldn't necessarily put me under for in adult world. Like, I think - I also had a spinal tap done to see if it had traveled to my bone marrow. And I was really glad actually that they did put me under for that, just because I think if I was awake, I would have just been really stressed about that too. But yeah, overall, the biopsies and the port placement were just kind of steps in the process. But it definitely caused a little bit of anxiety just because there was a lot of unknown there. And really one of the main things that I was nervous about, and this might sound a little superficial, but the scars. I mean, I don't know that anyone loves to have scars on their body. I think, you know, it's something that, again, I didn't want that negative attention that's like associated with “Oh my gosh, like, what's that?” And especially being in pretty visible places on my neck and on my chest, I was not about that. But thankfully the surgeons did amazing closing it in such a way that it's really not even that visible. And I mean, now I very much embrace my scars and I think they're just a huge part of my story and who I am as a person. But I think 18-year-old me was a little bit worried about the scars, but again, overall, I think surgery wasn't a huge part of my experience, but the minor surgeries that I did have, thankfully all went very well.
Kayla 37:26
Yeah, and I remember one of your ports got like a blood clot and you're the one that actually realized that it had that, because your veins were kind of popping up by your neck and you were just like, this doesn't feel right, it doesn't look right. So they did realize it had a clot in it. I don't remember, did they need to replace that one or were they able to bust the clot? I don't even remember.
Ella 37:47
I don't think they had to replace it. I think I just had two ports. Like, I think I had the port the first time around and then the port the second time around. So I'm wondering if it was just like the blood thinners took care of it. I honestly don't remember.
Kayla 38:05
Yeah, there are certain things you can put in a port, let it sit for a while, and then draw it off and it can sometimes dissolve clots. But yeah, it's really generous and nice of you to say it was not a big deal. I mean, that's not exactly what you said, but I've witnessed these ports being put in and taken out as a nurse and I mean, they are putting something in your chest. I’m sure it was sore for you, right? It's under your skin in there and you can kind of feel it through your skin. There's a lot going on there. And then, of course, we think about people who did have major, major surgeries. So that can mean limb removals, amputations, brain surgery, some of which people have to be awake for or some they don't, and then not really knowing… I mean, talk about not knowing what you'll feel like when you wake up. The brain is always very delicate and you're not sure if you'll need to relearn anything or if you'll have the same personality. That's freaky for people. Memory loss can also just come with what we were talking about with chemo brain and some of these even, like, anesthesia. Sometimes people have a little bit of memory loss around those couple of days. Another one that comes to mind is like colostomy bags. So colon cancer or people with bowel and digestive cancers or like urinary too. Sometimes people have bags forever or for a while after they've had surgery on those body parts. Obviously, we all think of the mastectomies. Those are kind of big in the media and that is a big deal. I mean, talk about, like earlier you were saying as a woman with your hair, like a woman with your breasts, that's got to be really difficult. So we wanted to hold space for surgeries, and I'm sure there are a million side effects that we don't even know about that come along with all of this, but that is not our area of expertise and not our firsthand experience. So if you'd like to let us know about your experience, feel free to reach out: Instagram, the website, our PO Box. But we just didn't want to not mention it at all. So that was our side effects episode. I hope you learned something. I hope it wasn't just a downer, but sort of opened your eyes a little bit more in a way that maybe will build empathy, or if you've gone through it yourself, that you felt seen. That's always our goal, is to educate, empathize and help people feel seen. So next week we're going to take a left turn and do something non-medical and talk about family roles. So, how families and relationships within those dynamics can be affected during the treatment phase of a cancer journey. How if you've got that planner sister, or that slack-off sister, or an overbearing parent, or a laid back parent, like these things that exist in our normal life can be amplified or turned on their heads in a time of crisis. So we'll be talking about family roles next week and until then, we hope you have the best week available to you.