Side Effects

A few years back I read a piece by Steve Martin in the New Yorker called “Side Effects.” I’d link to it here but I couldn’t find a copy not hiding behind a paywall, so I’ll just have to state that it’s worth seeking out. (It was included in his anthology, Pure Drivel.) 

I was thinking about Martin’s essay this weekend, as I decided it was a good time to read through the packet of information I was given at my first oncology appointment. The drug information sheets were particularly striking.

I was given sheets for five different drugs that would be part of my chemo regimen: bevacizumab, dexamethasone, fluorouracil, leucovorin, ondansetron, oxaliplatin, and prochlorperazine. Included in the information provided for each drug were the “common” side effects, “less common” side effects, and the things that, if they occurred, should prompt an immediate call to the doctor.

So across my five drugs? Fifty-two common side effects, sixty-four less common side effects, and seventy-nine things that should prompt an immediate call to the doctor. Of course the numbers drop significantly when you eliminate the duplicates (39, 54 and 41, respectively), but still.

But it’s not the number of items on the list (alone) that floored me, it’s what’s on the list. The following makes up the list of “common” and “less common” side effects, we’ll come back to the things that are supposed prompt an immediate call to the doctor.  And at this point I wish I was Gilbert or Sullivan or Rodgers or Hammerstein or some such, as this really ought to be set to music:

Dry skin, flaky skin; skin rash, skin reaction, skin irritation, including, but not limited to, burning, stinging, tingling, redness and/or itching; acne; skin darkening*; splitting fingernails; brittle hair, thinning hair, hair loss and/or increased body hair. (So you’re telling me chemo is like bizarro world puberty? Joy.)

Dry mouth, mouth sores, trouble swallowing, trouble talking, jaw tightness, odd feelings in your tongue and/or a metal taste in your mouth. (It’s probably inappropriate to suggest that the metal taste might be a function of the gun barrel.)

Loss of appetite, increased appetite, increased thirst; weight loss, weight gain, water retention; abnormal fat distribution. (Sadly, there are no photographs to document “abnormal fat distribution.” This I'd like to see.)

Constipation, diarrhea; frequent urination, trouble urinating and/or pink or brown urine; stomach ulcers, holes in your intestine; nausea, vomiting, stomach cramps and stomach upset. (Well, you can hardly blame the stomach for being upset with all that going on.)

High blood pressure, low blood pressure; bruising; blood clots, nose bleeds and/or serious bleeding; high blood sugar; low blood cell counts. (Although maybe the cells are just giving up and running away.)

Changed vision, blurred vision, cataracts, glaucoma and/or watery eyes. (Of course, those might just be tears from all these insane side effects.)

Irregular heartbeat, heart attack, heart failure; slowed healing and increased risk of infection; dizziness, headache, seizures, stroke; decline in liver function, decline of kidney function, bone loss. (Can we just go back to bizarro puberty?)

Scarring of the lungs, tightness in the chest and throat, trouble breathing and/or feeling like you’re not breathing even though you are. (OK, now you’re just yanking my chain. How are you supposed to distinguish between the imaginary breathing problems and the actual breathing problems?)

Muscle spasms, tremors; weakness, tiredness, weakness, restlessness, nervousness, inability to sleep and mood swings. (Yeah, my mood’s swinging already.)

Pain. (Sigh.)

And if that weren’t bad enough, we still have the items that are considered serious enough to require an immediate call to the health care team: abdominal pain, abnormal bleeding (versus normal bleeding?), allergic reaction, back pain (distinguished from my usual state how?), blindness, changes in blood pressure, changes in body temperature, changes in heart rate, chills, confusion, constipation, cough, dizziness, fainting, feeling like you are not breathing even though you are (again? this one again?), fever, flushing, headache, hives, irregular heartbeat, itching, jaw tightness, migraine, muscle stiffness, nausea or vomiting that doesn't go away, numbness, rapid weight gain, rash, redness, seizures, severe muscle pain or weakness, shortness of breath, sore throat, swelling of the face (oh good, I've been wanting to try out my Violet Beauregarde impression), throat tightness, tingling, trouble swallowing, trouble talking, uncontrolled movements of limbs or eyes, vomiting, yellowing of skin or eyes, and/or -- now wait for it -- “any other side effects or symptoms.”

Really? Are you kidding me? Short of my head falling off, what other side effects or symptoms could there possibly be that haven’t already been identified? And for that matter, those of you reading closely may notice there’s some significant overlap between the “call your doctor right away” list and everything that came before. This leads to the obvious question: how, pray tell, is one supposed to distinguish between, say, itching that warrants a call to the doctor and itching that's just par for the course?

Chemotherapy. Not for the faint of heart…