Chemo/GERD/ILD
 

I've been reading up on drug-induced interstitial lung disease (ILD) and gastroesophageal reflux disease (GERD). It's fascinating, but also kind of worrisome. This isn't internet chat room stuff. It's all from peer-reviewed journals and/or national web sites.

In an earlier post I shared that many chemo drugs can cause lung damage, and that oxygen treatment, radiation, aspirin, and nonsteroidal anti-inflammatory drugs (Motrin, Ibuprofen, Alleve, Naprosen) can also harm the lungs. In a more recent post I noted that acid reflux (called GERD when it's chronic) can make you cough. I reported that getting back on Nexium helped me.

It turns out I was wrong about coughing being my only symptom. Because I didn't have heartburn or that acid taste in the mouth, I didn't realize I had acid reflux. But there are other symptoms, including being out of breath, having trouble swallowing or speaking, and having a lump in one's throat.

It gets worse. People with asthma are highly likely to have GERD, and it's often "atypical" like mine. It's not clear which comes first, the chicken or the egg. They are definitely associated somehow. Furthermore, GERD can cause tiny droplets of stomach acid to get into the lungs, causing pneumonitis, pneumonia, or--you guessed it--interstitial lung disease. Many asthma medications (such as the Albuterol I was prescribed) can also exacerbate GERD.

It looks to me like I'm in a negative feedback loop. I think the chemo caused the GERD (and may have done some lung damage) but there was definitely coughing which, itself, can trigger GERD, which can also cause lung damage.

What to do? Well, the Nexium or another proton pump inhibitor is a good start. There are also lifestyle changes that can help, like not over-eating, avoiding fried, overly-acidic or spicy foods, not eating anything less than three hours before lying down (to go to bed), and cutting back on caffeine and alcohol. Those who are obese are also advised to lose weight. I don't drink carbonated beverages, but they are also implicated.

I love spicy foods, coffee, red wine, and chocolate (that's on some of the lists), but I'm also rather fond of breathing, so I'm willing to tweak my habits. Eating and drinking just got a whole lot less fun than they used to be.

I'm sharing this because pretty much every treatment we get, including Herceptin, has "interstitial lung disease" listed as a side effect. I have metastatic cancer, so it's easy for me to say I'll take the risk, given that I'd die of cancer if I didn't get treated. But if you're not Stage IV and you're having this kind of problem, talk to your doctor.

Re: Chemo/GERD/ILD
 

I didn't list all the symptoms of GERD, or all the aggravating factors. Here are some links.

http://www.aafp.org/afp/2008/0815/p483.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681743/

http://www.med.upenn.edu/gastro/GERD.shtm

Note that the last article (from University of Pennsylvania) says there's no evidence that changing diet does any good.

Re: Chemo/GERD/ILD
 

Amy, did you have asthma before BC and your treatments?

I did not have asthma beforehand, but about 3 years ago I developed the main symptom of having difficulty breathing, mostly when exerting myself - climbing stairs especially. I went to my GP (terrified I had lung mets), but she did not think so, and after sending me for a chest Xray (clear) she sent me for one of those tests where you breathe into a long tube for various amounts of time. I could barely do the test. Test results came back as asthma, which totally floored me, but hey, I'd take asthma over mets. She put me on an Advair 250 mg. discus, 2x/day, but I usually only use it once/day. I just prefer not be on those steroids if I can avoid it.

I truly think the asthma is a late side effect of Herceptin, as shortness of breath is one of the many s/es when on Herceptin. I did not have shortness of breath while on it, so who knows? My oncololgist noted this "new" asthma in my chart. So far I do not have any kind of GERD, indigestion etc. I too love spicy food, tomato sauce etc., so will be aware of this possibility.

Thanks for the info.

all the best
caya

Re: Chemo/GERD/ILD
 

I developed GERD along with chemo. Still have it. I use zantac twice a day.

Re: Chemo/GERD/ILD
 

Amy,
Try Limonene for GERD. It's all natural. Google for information you seek.
All's well, and hoping the same for you,
Karen

PS-Read the testimonials at the bottom.
http://www.amazon.com/Jarrow-Formula...rds=d-limonene

Re: Chemo/GERD/ILD
 

Caya,

I didn't have asthma before breast cancer treatment.

I've figured out that lungs are complex.

Good to hear from everyone. I think I'm going to get this resolved--soon I hope.

Re: Chemo/GERD/ILD
 

What timing! I haven't posted for awhile as I've been struggling. One of my struggles is shortness of breath and diff swallowing. I've also had pleural effusion I've had drained twice. Likely many of my symptoms from that but I've had the dry cough and diff swallowing prior to effusion. Had GERD w reflux after colon blockage but reflux went away and this started long after. Hoping I can solve at least some of the issue w the protonix or nexium etc. will be calling onc tomorrow.
Thank you for posting!
Cathy

Re: Chemo/GERD/ILD
 

Dear Cat,

Oh, I hope this helps you!

It's so complicated, all the effects and side effects. I can say I'm doing much better. I took a nice deep breath when I woke up this morning and didn't cough.

Mostly I'm just paying more attention. Now that I know what to look for in terms of the atypical symptoms, I can take more control over managing the condition.

The articles on atypical GERD caution about the need to diagnose carefully, but my layperson's opinion is we can go ahead and assume that chemo caused it. Tykerb and Kadcyla both list interstitial lung disease as potential side effects. My lung difficulties started when I was on Tykerb, and got much worse on Kadcyla. I've been off Kadcyla since February, but other side effects are still present (low platelets & elevated liver enzymes.)

Good luck. Let us know how it goes.

Re: Chemo/GERD/ILD
 

I have a partial update.

One other thing I've been experiencing is dizziness and near-fainting. And I sometimes just run out of air through my larynx in the midst of talking or singing. I sing in a choir, so that's an issue.

It's possible that it can all be traced to the vagus nerve--the fainting/lightheadedness, the GERD, the voice problems, and maybe even the diarrhea. I'm not quite sure what to do with this information, but I'll keep you all posted. Here's a Wikipedia article about the vagus nerve: http://en.wikipedia.org/wiki/Vagus_nerve

One clue for me is that none of the usual dietary triggers correlate with my GERD. That's good--I like my wine, coffee, chocolate, and spicy and/or acid foods. I still need the medication, but I'm chasing down a suggestion I heard this week that an overactive vagus nerve can be trained somehow. I'll keep you all posted.

Re: Chemo/GERD/ILD
 

I'm bumping this up with an update.

I was a couple days late picking up my Nexium refill, and the dry cough and difficulty swallowing came right back. So when I got in to get the prescription Nexium, I also bought some over the counter. (It's expensive either way. The prescription has a $35 copay for 30 days' worth, but 21 days' worth of OTC Nexium cost $24, and it was on sale. The OTC dose is half the prescription dose). But this way I have backup.

The "vaso-vagal syncope" (i.e. feeling suddenly light-headed and nearly fainting) is better. I learned a trick of holding my breath and clenching all the muscles in my torso as hard as I could until the spell subsides, which usually only takes a few seconds.

I still sometimes run out of air while talking or singing. I think maybe staying well hydrated helps there, but I'm not sure.

Re: Chemo/GERD/ILD
 

Thanks for sharing your research. I hope you continue to find relief. Grrrr on Gerd!

Re: Chemo/GERD/ILD
 

As I told my roommate, once I realized the GERD isn't just annoying and inconvenient, but might be harming my lungs, I became more militant about managing it.

My main treatment side effect is diarrhea. Wouldn't you know, Nexium can cause diarrhea. Can't win.