Transcript
WEBVTT
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So the heart is a muscle all by itself, pumping 24 hours a day, seven days a week throughout our entire lifespan.
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And there are certain treatments that specifically are toxic to the heart muscle itself.
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And Leah, I think you had one of them.
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Yes.
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What did you have?
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Well, two of them, right?
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At AC.
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So, adriamycin and cyclophosphamide.
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Mm hmm.
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And adriamycin is also known as the red devil.
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And so adriamycin causes not just heart disease, Immediate effects, when someone's getting it, delayed effects, and does that concern you at all?
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Oh, absolutely.
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Oh, oh my god.
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Oh my god.
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Absolutely.
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All the time, I think about it.
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Because I also have a family history of heart disease.
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So, you know, cancer treatment is the gift that keeps on giving.
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You know, it's like for all of the good that it does, there's this kind of like threat
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Sequelae.
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sequelae, delayed side effects.
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We call them sequelae in medicine, but yes, most people just call it a delayed side effect.
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And specifically for cardiotoxicity or heart toxicity, some of these drugs don't really manifest any symptoms until seven years, ten years, down the line, where people have fatigue.
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I mean, that's usually the first symptom.
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When the heart is not pumping well, people are tired.
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Yeah.
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So I had some weird heart symptoms that were happening, I think back in like 2020, 2021.
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And I underwent a stress test because that was my concern.
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Right.
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and yeah, they did the stress test and they're like, you're great.
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Well, that's good.
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like, have you ever done a heart stress test?
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They're stressful.
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By design.
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I thought for sure I failed.
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I thought for sure I failed.
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Cause I was on that treadmill and I was like.
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Wheezing practically, and they're like, Oh, wow, you're healthy.
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I'm like, yes,
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All right, well, we will talk about what keeps the heart healthy and how to make sure some of these side effects that happen over time don't happen to our listeners.
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I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one
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and I'm Dr Leah Sherman and on the cancer inside
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And we're two naturopathic doctors who practice integrative cancer care
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But we're not your doctors
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This is for education entertainment and informational purposes only
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do not apply any of this information without first speaking to your doctor
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The views and opinions expressed on this podcast by the hosts and their guests are solely their own
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Welcome to the cancer pod
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Hi, Leah.
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hi, Tina,
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So in this episode, we're going to talk about cardiotoxicity.
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heart toxicity.
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Specifically, we're going to talk about risk factors, you know, what makes someone more vulnerable to toxicity of these treatments.
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And What treatments specifically are associated with the highest risk of damage to the heart muscle itself and how to lower one's risk.
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So actively, what can people do in their self care and day to day integrative medicine approach?
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And we're going to talk about supplements and herbs, things that we know work.
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we're also going to talk about things you can do during treatment to decrease your risk.
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Yes.
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Yep.
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A little more controversial just because some cancer centers don't allow people to do things during treatment, but there are some well evidenced approaches during treatment that actually lower your risk.
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Yeah.
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So let's start with, um, some of the risk factors and I guess the biggest risk factor, To some might kind of be obvious, it's your risk factor for having cardiovascular disease in the first place.
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So like a history of smoking, high blood pressure, diabetes, obesity, or just like I said, like having a history of heart problems is going to make you more likely to have heart problems.
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From your treatment.
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Um, Age.
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So, being over 60, it also can affect really young children, And then, being female.
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Yes.
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of the, one of the joys of being female.
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it to the list.
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Yeah, yeah, you know, it's a special perk.
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and like you mentioned, like there are certain drugs that people receive.
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So the one that I received, the, Adriamycin or doxorubicin, same thing, getting high doses of that.
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And that drug actually has a lifetime limit of how much you can receive because of the potential for heart issues.
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In that class of drugs, anthracycline is dose dependent.
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So the more you got for treatment or the more you're getting, the higher the risk of heart toxicity.
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Okay.
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Right.
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And then combining those anthracyclines with radiation therapy further amplifies it.
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Yes, and coupling it with another treatment that happens to have some heart toxicity as well.
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So when you're doubling down, you're getting two agents for your cancer.
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They're anti cancer agents, but they're also both toxic to the heart.
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And one that stands out in that arena is Herceptin.
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Right.
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So if you, which I don't really think it happens so much anymore, but if you get Adriamycin, Red Devil, you get the Red Devil and then you follow that up with Herceptin.
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Yeah.
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But they don't really do that.
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No, not so much anymore because of that cardio toxicity, but there could be listeners that have gotten that in the past.
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Absolutely.
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Yeah.
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Yeah.
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And as you mentioned, like some of these side effects might not occur until much later, but some of them happen actually as people are getting treatments.
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And The one that I think of most often that, that happens with is Herceptin.
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And part of that is because, I mean, people get Herceptin for long periods of time.
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Mm hmm.
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They'll get it over the course of a year, typically with breast cancer treatment, but some people are on it for life.
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Yeah.
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And, um, when we say Herceptin, we're using that drug as a generic in that class.
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So anything that's Herceptin like, so Progetta is a newer version of Herceptin.
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Yeah.
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And you're giving, you're giving the brand
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I am, because that's what people usually know.
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I don't want to,
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Trastuzumab.
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yeah, if we want to say Terastuzumab, we can, but I think it might be a little bit of a tongue twister.
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First of all,
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Yeah.
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For us.
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first of all, this is a podcast, so I don't really want a tongue twist, but
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Yeah.
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and the, the, the cardiotoxicity is it's varied.
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It's everything from having high blood pressure, which also happens with Herceptin.
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I had to stop myself from saying Trastuzumab, um, it also happens with Herceptin and other drugs too, right?
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I mean, drugs that affect your kidney are going to increase your blood pressure.
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Yeah.
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Right.
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So when you're talking about the heart muscle, you've got direct toxicities like these anthracyclines, but you also have, it's a system, you know, so anything that raises your blood pressure puts pressure on the heart because the reason that happens is when you have high blood pressure with each pump of the heart, you have to pump the blood out against a larger pressure and that can result in a cardiomyopathy, which is just a fancy word for heart damage.
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So that can be direct or it can be indirect through hypertension.
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So it'd be direct literally that it's toxic to the cells, they are damaged, and they may or may not revive from the damage.
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So What we're talking about today is, you know, it's a muscle.
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The, the beauty of this is it is a muscle and it has a lot of healing potential.
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I always think of different organs in the body as having different healing potentials.
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When you have the heart muscle you're talking about, it's got a lot of inherent ability to repair damage.
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So as long as you get it early enough and it's not completely dead cells and they have potential to heal.
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So one of the most commonly thought of chemotherapies that damage the kidneys and can lead to heart problems is cisplatin And that's commonly, used in patients who have lung cancer paired with radiation.
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Yeah, yeah, it's also commonly used for ovarian cancer.
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It's a, it's a really commonly used chemo in general.
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I mean, for the last, I don't know how many decades.
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I mean, cisplatin has been around a very long time.
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Yeah.
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And at the time of this recording, um, there is a shortage of it as well.
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Yeah, that's a whole nother, gosh, that'll be an interesting kind of, I don't want to call it an expose, but at least talk to people in the know, um, when there are drug shortages, how that is handled behind the scenes.
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Because I think that there's a lot of, um, yeah, there's a lot of unfortunate things that happen when they have to figure out who gets it and who doesn't get the drugs.
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Right.
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Um, okay.
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So moving along the other things that can happen, uh, high cholesterol.
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I'm kind of starting at like the lower end and then we're going to work our way up.
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Okay.
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I see.
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Yeah.
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See, I'm not going to start with like the big, you know, the big issues.
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We're going to say high cholesterol, which is something also that people don't think about, especially the hormonal agents, or I should say the anti hormonal agents.
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Cause once you start messing with the hormones, you're messing with the cholesterol and yeah,
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True that.
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Yes.
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Yeah.
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Yeah.
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Yeah.
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So some of the drugs like tamoxifen.
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can cause cholesterol to go high and cause triglycerides to deposit in the liver and actually cause dysfunction of the liver over time.
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So this, these things have to be weighed when people are taking this drug for five years.
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We know that it's, the benefits outweigh the risks for most people, um, but over longer periods of time, because they're looking at 10 years and even longer now, you have to weigh the.
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risk for each individual for high cholesterol, liver deposition of triglycerides, and blood clots because it does increase blood clot risk in some people.
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right.
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And cancer treatment itself puts a person at higher risk for blood clots.
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Yeah.
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As does the cancerous process.
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So cancer, sometimes we know in certain cancers, especially if it's extensive, if someone has stage three and certainly stage four, we have to be on the lookout for high clotting risk.
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So people are more likely to have a blood clot.
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form, um, whether, you know, it forms in their lungs or legs or, um, a stroke even, or a heart attack.
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We have to be very mindful that that event can occur, not to be a major downer, but it's just one of those things we need to know, right?
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You need to have it higher on your list of possibilities.
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Arrhythmias or like.
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You know, when your heart rhythm isn't what it's supposed to be.
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it's when your heart is beating irregularly.
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and that is why with certain treatments, you're getting EKGs beforehand, um, echocardiograms are another way of seeing how your heart is functioning.
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Um, so what I find interesting with the arrhythmias, there are medication warnings saying like, this may increase risk of long QT syndrome.
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And you're like, what does that mean?
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And that's seen on an EKG.
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Um, so a lot of medications can cause that from medications you're taking to decrease side effects to actual.
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Cancer treatments.
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And so, and then patients come in taking medications themselves that may have that as a potential side effect.
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And so that's kind of compounds, um, the risk.
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Yeah.
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And this is something, I know that our fellow colleagues know this very well, but I, just for the.
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People who are not medically trained out there, and EKG is looking at the electrical impulses through the heart and can see arrhythmias through the electrical impulse Now, this is independent of your entire nervous system.
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It is connected, but not directly, right?
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So we have something called heart rate variability, but that's a whole nother conversation.
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And when you're getting an echocardiogram, that's actually looking at the plumbing.
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So EKG is the electrician looking at it, measuring it, seeing what it looks like with electrical flow and an echo or echocardiogram is the plumbing, how much volume of blood is coming out with each pump.
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What does the blood look like as it goes from one part of the heart to another part of the heart, right?
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And so I just like to like prove that to people so that they kind of understand what they're getting tested or what it might be.
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The echocardiogram is something that I think people probably should get just to check if they're having any kind of symptoms, if they're 5 and 10 or even 15 years out from a drug that was toxic to their heart.
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It's one, it's higher on the list, like get an echocardiogram, make sure your heart is pumping properly and that the blood flow is reaching your, your organs and your, your limbs.
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And it, it's cool.
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It's, it's an ultrasound of your heart.
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Like it's really kind of a cool thing to, to see.
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It's also like a measure of the strength of each pump, right?
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So the ejection fraction.
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That's what it's called.
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How much blood comes out with each pump of the left ventricle of your heart, that ejection fraction has to be a certain number, a percentage.
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Because it doesn't pump everything that's in there, it doesn't squeeze it completely.
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completely clear.
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So a healthy ejection fraction is 55%, for example.
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And then if you get a treatment that's toxic to the heart and that your 55 becomes 45 or 40 or 35, don't despair because it's a muscle.
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You can build it back.
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You can do things to improve that function.
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And this is routine for us in naturopathic medicine and other integrative practitioners out there.
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Building back the heart muscle with proper diet, exercise, and nutrients and supplements is very, very doable.
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That's why I call it more resilient than a lot of other organs.
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You can see it measurably get better.
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And for people who have received Herceptin, that is something that is checked regularly.
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And so they're familiar with going in and getting their echoes to, to check that out.
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So, um, you kind of touched on cardiomyopathy, which is damage to the actual heart muscle, and that can lead to congestive heart failure.
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Yeah, there's different types of cardiomyopathy.
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I won't go into those kind of details, but the real danger with cardiomyopathy is congestive heart failure, which is When your heart is no longer capable of pumping enough blood for your function, right?
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It's also an enlargement of the heart.
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Sometimes this can be picked up on a routine x ray.
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You go in because you have a cough that won't go away.
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You get a chest x ray and they can see the heart shadow.
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It looks a little enlarged and you go on to get a further workup from there.
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So congestive heart failure is something that happens usually in the aging process or when the heart has a hard time pumping against the wall.
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So if someone has blood pressure that's high and untreated, eventually you get cardiomyopathy and that cardiomyopathy can eventually evolve into congestive heart failure.
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So this is why you do want to treat a high blood pressure.
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You don't want that to be, you know, too high.
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It's too stressful on the heart muscle.
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So two other issues that can come up are myocarditis and pericarditis.
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Itis is never a good thing.
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Well, it is true.
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Itis means inflamed, right?
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It's inflammation.
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So myocarditis is inflammation of the actual heart.
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Cardiomyocytes, which are the cells that make up the muscle of the heart, and pericarditis is inflammation of the membrane that's around the heart.
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So there's a nice kind of sack around the heart and pericarditis can happen as a side effect of some of these treatments.
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One that I was reminded of, and I had forgotten actually, is aromatase inhibitors can cause pericarditis.
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And I have only seen that once, it can't be very common.
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But I did see it once and I remember it being in a woman who had pretty severe side effects otherwise from the aromatase inhibitor.
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Like most people would have quit it by then because it was, it was incapacitating joint pain that she had and she stayed on it.
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And so when she came to see me in that first visit, she already had really bad joints and pericarditis.
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And so she finally had gotten off the drug and wanted to know what else she could do because she had to get off the drug.
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But only once.
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So I, when I came across it in my reading, I was like, Oh yeah, that's a.
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Rare, but real side effect for a few folks out there.
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I call them rare, but real because, you know, it doesn't help someone who's suffering from a rare side effect to hear that it's rare.
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Well, somebody's gotta be that one percent.
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I mean, I had so many weird stuff happen to me during my treatment, and they're like, oh, this really doesn't happen.
00:15:48.376 --> 00:15:49.376
This is really, really rare.
00:15:49.376 --> 00:15:50.667
I'm like, what's gotta happen to somebody?
00:15:50.897 --> 00:15:52.277
Somebody's gotta be that one percent.
