Comprimised immune system?

[Sherryg683]

Just wondering if after chemo our immune systems eventually go back to normal, and if so how long? It's been almost a year and a half and I still seem to catch everything and everyone, including doctors refer to my weakened immune system. Anyone know the answer to this..sherryg

[hutchibk]

I am only guessing, but I would tend to think that we stay somewhat compromised forever... I am getting my flu shot tomorrow!

[tousled1]

Sherry,

I think that we all have a compromised immune system and I'm not sure anyone knows how long it will last. Remember we have had all kind of toxic chemicals pumped into our system - it does more than just kill the cancer cells. I sincerely believe that what was my "normal" will not be what my "normal" is after breast cancer treatment. We just have to adjust and go forward.

[PinkGirl]

Hi Sherryg

I agree with Tousled and Brenda - I'm not sure we ever get back
to "normal". I finished everything in January. My last blood work
was the "low end of normal" for everything, and just one speck below
normal for my white cells. I still am very careful about being around
sick people and I'll also be getting my flu shot next week.

[MJo]

Funny you should mention compromised immune system. I just got my flu shot this morning and wondered if I would have a stronger reaction this year. So far I'm fine. My last Herceptin was November 2006, and I am just starting to feel strong again. Also, during treatment I had two painful ankle strains/sprains and three hairline fractures in my feet/toe, plus hairline fractures to my ribs. I ended up at the beach with a wrapped ankle and on a cruise with a broken toe. I haven't broken/strained anything for six months. It got better for me, thankfully.

[AlaskaAngel]

I just had my flu and Pneumovax injections too and wondered whether I should or not. I worry about whether or not the inflammation response that occurs with vaccination is a problem of any significance. I don't understand well enough whether it is more important for a person who has had cancer to avoid the inflammation that comes with vaccines, or if the vaccine is more important. My thought was to take an anti-inflammatory (especially since my arm hurt from getting both shots in the same arm quite a lot). But then I wondered whether the inflammation response is necessary for some length of time for the vaccine to be fully effective?

Obviously what I don't know about this is greater than what I do know!

So.... I let the vaccine work its stuff until my arm felt so painful that I was awake at 2 AM unable to sleep before caving in and taking an 81-mg aspirin.... and then 2 hours later, another one.

Do any of those who are in the vaccine programs for HER2 know whether taking an anti-inflammatory is a better or worse thing to do when getting vaccinated for someone who has had cancer?

AlaskaAngel

P.S. Isn't it sad that something so universally important as the question that is being asked here about whether the immune system is permanently damaged by treatment is not clearly explained to us prior to treatment, after so many years of masses of humans going through the treatments?

[Hopeful]

A.A. wrote:

"Isn't it sad that something so universally important as the question that is being asked here about whether the immune system is permanently damaged by treatment is not clearly explained to us prior to treatment, after so many years of masses of humans going through the treatments?"

You have clearly elucidated the single overriding reason I declined chemotherapy for Stage 1 bc, after learning that, as a post-menopausal, strongly hormonally positive patient, I would see the lowest percentage of benefit of any group from the tx.

Hopeful

[Sheila]

If indeed we are immune system compromised for a long period during and after chemo, or possibly forever, that would seem to be all the more reason to get the pneumovax and influenza vaccines, the pneumovax must be repeated every 5 years, the flu shot yearly...and this doesn't look promising for all the cases of MRSA that are showing up...and hospitals are full of it! Kind of scary seeing as how we all go there to get better....I carry a bottle of hand sanitizer with me wherever I go now....I just read that the one child who died from MRSA in the past week was immune compromised due to cancer.....

[Andrea Barnett Budin]

This question of suppressed immune system potentially forever is why I take the immune boosting supplements I do. And I get the flu vaccine ea yr. I didn't have residual pain in my arm after this shot and though glad, wonder... Why??? I think we must protect ourselves as best as possible.

I prefer HUGS to handshakes. Really! Hugs are very therapeutic. Whereas handshakes... I flush toilets w/the bottom of my shoe. I push doors open w/elbow if possible. I try not to get crazy. http://cdn-cf.aol.com/se/clip_art/gstres/thghts/smileI smile a lot. And laugh every day!

Andi

[Barbara H.]

I teach third grade and come in contact with of lot of colds, strep, etc. Since I am stage 4, I am always in treatment. I feel that my immune system is strengthened by the exposure I receive. It is similar to what happens to new parents with children who attend day care or preschool. The first year everyone is sick in the family, but eventually the parent's immune system is stronger. This also happens with first year teachers. They are often sick in during their first year of teaching.

I know we have to be careful, but I don't think it hurts to get out and live the lives we desire.

Best regards,
Barbara H.

[fullofbeans]

Well I may a bit differ from the other answer but I feel that my immune system is back to normal despite all the chemo I received..perhaps it just vary from person to person age ect..but never read anything on this indeed, would be good to see some studies I suppose.

I say that I think I am fine because I have had no cold for a very long time whereas many of my friends who never had chemo did.

I too I am careful now and will for example not share glasses and avoid people with colds, but I think that it is habit I have taken since chemo. I don't know about you but man I can be vain about it! since I want my body to be fighting cancer not some second rate cold.

Good idea I think about flu jab

[KellyA]

Hi there,

I was wondering about the whole immune system thing myself. Prior to cancer, I never was sick. It had actually been 10 or 15 years since I had been to the doctor for any illness. Have never had the flu or strep, just a few runny noses. Sailed through chemo without getting sick, even with counts in the gutter and worked at a preschool with 2 and 3 years olds the entire time. Now I am in an elementary school, and I seem to be picking up every sore throat and cold that passes through. I had the chance to get a flu shot last week and wasn't sure if I was supposed to get it, or not supposed to. Now I am thinking that I should have gotten it. I find it strange that after everything in the last year and a half that I am just now having problems. Maybe its that first year teaching thing.

Love, Kelly

[Mary Jo]

I, too, feel my immune system is fine, at least as far as sickness goes. I've been fortunate as far as colds and flu go. Neither during or after chemo was I struck down with any of that. However, one thing that is different about me now is that I am very sensitive to antibiotics. I was just put on an antibiotic for a bacterial/yeast infection - I only took 2 of the pills and major rash/hives swollen face, red etc. I ended up going to the health food store to get something to treat it with their. After my 1st mastectomy (10 days after) I broke out in severe hives - like saucer plate size - that lasted for 2 weeks. We still aren't sure what brought those about. After my prophylactic mastectomy I noticed small hives on my arms but thankfully they didn't turn into anything serious. I often wonder what I'll ever do if something really bad happens to me and I'd need an antibiotic. I'd be afraid to take it.

That's my 2 cents.

Mary Jo

[weezie1053]

I was suppose to get the flu and pneumonia shot last week with my Herceptin appointment. Thanks for all of the reminders. I just emailed my Oncologist and reminded him to order it along with my last Herceptin treatment.

Louise

[Grace]

Kelly,

I received this alert today on the flu shot for women with breast cancer. Hope this helps.


At a Glance

EGG ALLERGY ALERT:

The virus in the flu shot is developed in egg products. If you are allergic to eggs, discuss with your doctor whether you should get the shot.


Flu shot

The flu arrives in most areas of the United States during the winter months, and flu shots are usually available several months before that. It's particularly important for women affected by breast cancer to get a flu shot.
What is a flu shot?

The flu shot, or influenza vaccine, is a mixture of dead flu viruses that prepares the immune system to fight the actual virus if it enters the body. It's like giving a search-and-rescue dog a shoe to sniff so that the dog remembers the scent and can find the owner of the shoe. The immune system remembers the viruses in the flu shot, and is ready to attack if one shows up in your body. The viruses are destroyed quickly, before you come down with any symptoms.
Getting the shot does not guarantee that you won't get the flu, but it does mean that you have a much smaller chance of getting sick from it.
Why is the flu shot important for women affected by breast cancer?

There is a common misconception that getting a flu shot may be harmful if your immune system is weakened by disease or treatment. Getting a flu shot is particularly important for people with weak immune systems, because they are the ones who are the most vulnerable if they actually catch the flu. These people include babies, the elderly, people with allergies, and people with chronic or acute illnesses.
When should you get the flu shot?

Try to get the flu shot two months before the flu usually hits your area. Some areas are affected earlier than others. Many areas are hit in January and February, so the time to get the shot is November or December. Ask your doctor about the recommended time for your area.
People receiving chemotherapy can get the flu shot any time. However, your doctor might advise you to wait and get the shot when your white blood cell count is at a peak, usually the day before your next treatment. There are two reasons for this:

The higher your white count, the more effective the shot will be. A low count is like a search-and-rescue dog with a weak sense of smell. The weaker its sense of smell, the less likely it is to recognize the owner of the shoe. Your immune system will be able to fight the flu better if there are more immune cells around to "sniff" the viruses in the flu shot.
Side effects of the flu shot might be confused with infection. Chemotherapy lowers your white blood cell counts. When your counts are the lowest, your risk of infection is the highest. During treatment, your doctor watches you carefully for signs of infection, like fever. But the flu shot can also cause a fever. If you get a fever while your counts are low, your doctor has to treat you for infection, possibly with unnecessary hospitalization, tests, and antibiotic therapy. Your doctor may not want to introduce this confusion when your risk for infection is highest.If your counts are chronically low, generally you can receive the flu shot any time.
Ask your doctor when is the best time for YOU to get your flu shot. And make sure to get the "OK" from your cancer doctors first.
Who should give you the flu shot?

Any qualified medical person can administer the flu shot. However, some insurance plans cover the flu shot only if you get it from your primary physician. Find out what your policy covers before you decide where to get the shot.
Does the flu shot have side effects?

In most people the flu shot causes no reaction. The viruses in the shot are dead, so you cannot get the flu from it.
In some people, the flu shot may cause mild side effects, including soreness, redness, or swelling where the shot was given, fever, and aches.
These mild symptoms usually begin soon after the shot is given, and last one to two days.
Like any medication, the flu shot can cause a serious allergic reaction, but the risk of this is very small. If you have any unusual problems a few minutes to a few hours after getting the shot, such as high fever, difficulty breathing, hives, weakness, or dizziness, call your doctor right away.
For more about flu shots, you can download information (http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf) from the Centers for Disease Control web site.
Pneumonia shot (pneumococcal vaccine)

What is the pneumococcal vaccine?

Pneumonia — a bacterial infection in the lungs — is a common complication from the flu. In addition to a flu shot every fall, it's a good idea to get a once-in-a-lifetime pneumococcal vaccine.
Why get the pneumococcal vaccine?


The shot protects against almost all of the bacteria that cause pneumonia.
It's safe.
It's covered by Medicare.
Most people only need one shot to protect them for the rest of their lives.Who should get the pneumococcal vaccine?


People age 65 or older;
People with a chronic illness such as advanced breast cancer, heart or lung disease, or diabetes;
People with a weak immune system due to illness and/or the effects of chemotherapy;
Residents of nursing homes and other long-term care facilities; and
Alaskan Natives and certain American Indian populations.What are the side effects of the pneumococcal vaccine?

You cannot get pneumonia from the vaccine. Some people may experience mild side effects, however. These can include swelling and soreness at the spot where the shot was given. A few people may experience a fever and/or muscle pain.

[AlaskaAngel]

I received the same e-mail info. In all that they did say, they don't comment at all about all the importance of COX2 in regard to the question of inflammation from vaccines for those with cancer or a compromised immune system. I don't know from the info they provided whether or not the inflammation response from immunization could contribute to cancer/recurrence or not.

A.A.

[Lani]

Breast cancer itself, especially her2+ breast cancer has multiple effects on the immune system which result in the immune system not being able to effectively recognize the breast cancer and fight it, whether utilizing the humoral or the cellular parts of the immune reaction. Some of these methods are physical (secreting a greasy coating so the antigen cannot be recognized by the antibody), some are chemical eg, secreting substances which keep certain subsets of cells like dendritic cells from maturing and learning to fulfill their function, and many have not yet been worked out.

The radiation therapy given for breast cancer affects the thymus gland(which produces cells required for the immune system) and papers from the early 1970s and 80s showed that many subsets of cells involved in the immune system stopped being produced and were not produced even 8 years after the radiation therapy typically given for breast cancer

The chemotherapy given for breast cancer is toxic to cells which divide quickly, notably the cells which become subsets of the white blood cells, red blood cells and platelets and these interact with tumors, other immune cells with complicated feedback mechanisms. Occasionally they are so toxic that the cells which become these cells die, resulting in aplastic anemia or myelodysplastic syndrome (I have posted on this and one of our members has had this)

This is why it would be optimal for her2 to be included in the Adjuvant online estimation of risk of recurrence--so informed decisions can be made regarding the ABSOLUTE not relative risks of recurrence of breast cancer vs the small but present risks of developing second cancers, leukemias, etc.

I will shortly post a recent article on the risk of recurrence of T1a or 1b, NoMo breast cancer (not taking her2 into account) it cited a Breast cancer related 10 year death rate of 4% with a nonbreast cancer related death rate of over 20% as I recall. Some of those nonbreast cancer related deaths may have been due to complications from the breast cancer treatment, both from the radiation therapy, the chemo and the antihormonals, and a few from cardiotoxicity from herceptin(as it has not been used in the adjuvant setting that long).

We don't understand the normal immune system that well, let alone the suppressed one. I have proposed to several researchers that they look at the difference in the immune system between those treated without radiation therapy, those treated with whole breast radiation therapy, and those treated with APBI (just the lumpectomy cavity and in many fewer treatments over a much shorter period). New technology at Stanford will make such studies possible. I share your amazement that this hasn't really been studied before, but it seems the technology and knowledge just weren't there. The new head of the Stanford division starting to study the immune system cells this way says they first have to study a lot of normal people, as they really don't know what is normal yet!

Another example of how much we don't know--reminding us to keep asking questions!

[sherri]

For me it seems the opposit. Before BC, I used to catch any cold virus around me, after BC and I must say after the HER2 Vaccine, it seems I don't get flu or cold at all. But on the other hand, I'm very sensetive to mosquito bites etc... and I've developped alergy to lot of things that I never had before!

[AlaskaAngel]

While it could be coincidence, I got both the flu vaccine and the Pneumovax last Monday, and today for the first time in over 10 years, the one small area on my face where I once had a considerable breakout of herpes simplex, is showing early signs of another breakout. The interval would be about the right time span for cause and effect.

AlaskaAngel

[Barbara H.]

I must say that Lani's post gave me some concern since I am exposed students who are sick on a daily basis. I thought is was alarming to read about the potential damage to the thymus gland. Considering all my treatments, radiation treatment was the most upsetting. My stereotactic radiation to the brain caused necrosis and I have had to have two surgeries as a result. At this point the MRIs indicate that this effect is subsiding. I certainly hope that I don't have anymore issues with brain mets. I really do not wish to receive any more radiation.
Barbara H.

[AlaskaAngel]

I found an article discussing a different vaccine, but talking in general about the general same ideas. It doesn't answer the question I have about inflammation from vaccination possibly might not be such a good idea for those who have had bc, but it does address the question about whether being immunized could be a wasted effort if you take anti-inflammatories at the wrong time to discourage the resulting inflammation. I thought the comment attributed to Dr. Phipps was worth sharing. (You can also bring up the article by using "COX2" and "vaccination", if you don't want to sign into medscape, and then choosing COX2 Inhibition Reduces Immunogenicity of HPV Vaccine"):

http://canadiancpd.medscape.com/viewarticle/549869

According to Dr. Phipps, "further research is needed to determine how the timing and dosage of NSAIDs affects the antibody response to vaccination." Until then, he believes it is probably prudent to refrain from NSAID use for at least a week or two before and after receiving a vaccine.

J Immunol 2006


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[Lolly]

Here's the article AA cites:

Painkillers May Threaten the Power of Vaccines
http://vaccines.wordpress.com/2006/12/09/painkillers-may-threaten-power-of-vaccines/

[michka]

Sherry, thank you for your post. I did not know that my immune system would not recover well from chemo and radiation. I thought it would recover within a year. No doctor ever told me that although I asked and insisted to know about the secondary effects of the treatments. I will ask for the vaccinations. Thank you Lani for all your contributions. I learn every day.
Michka

[karen raines hunt]

I finished the hard chemo (A/C and Taxol) in Oct 2005, finished radiation treatments in Jan 2006 and finished my year of Herceptin in July 2006. I had 1.5 yrs of Tamoxifen and now am on Aromasin. My recent blood tests showed my WBC below normal. Our blood cell producing tissues.........the bone marrow "take a hard blow" from the drugs and radiation. It is worrisome, but I think "par for the course."


Karen

[myraazzopardi]

Hello Sherry. Is it bad luck to say so far so good with my immune system.
I had my chemo up to October 2006 and RT. finished in December of 2006. I was as all of us as thin as a stick no hair but no colds no coughs up to now whilst during these last two winters family and friends around me have groaned and mouned at their afflications of flu etc. Can it be that I went on a special eating routine. All organic (broke the bank) Five fruit and veg a day raw or juiced. during the chemo miso soup lots of tahini pumkin seeds etc. No meat no dairy products whatsover. I am not on Herceptin and my onc tells me I have the heart of a bull and my blood seems to be perfect. My nails kept growing strongly. My hair has grown back (like a hamster though) Is there something in this diet thing. Health to all my strong and brave sisters. Now tears thinking of you all. Its emotions that I have suffered with. Still positive.

[myraazzopardi]

I said not on herceptin. Mistake. I am on herceptin.

[Lani]

as I understand it , cyberknife type radiation is so concentrated, that scatter is much less to the thymus and bones with marrow with blood-forming potential

It is the external beam radiation given for breast cancer which was studied in the papers I quoted.

Noone has been studying this in breast cancer patients much of late.

I suggested to someone doing a trial of accelerated partial breast irradiation, that they study the immune system of those who do not get radiation therapy, those who get APBI and those who get conventional radiation therapy, but I think the problem is getting the funds.(no drug company support,)few studies look at whether less of a tretment is equivalent to more because of legal reasons and probably difficulty finding willing patients.

[CLTann]

I have posted several times that for most people the flu shots are useless because only two or three strains of flu are in the shots. There are hundreds of different strains of flu that are not protected. It is a very remote chance that the popular flu for the year is indeed in the vaccine. The immediate reaction to the flu shot will immediately be felt by the patient. Doctors follow their guidelines and always advise patients to take the flu shots. Ask these doctors whether they themselves got flu shots and you will be surprised to learn that only a few actually took the flu shots.

Again, the immediate side effects of chemo and radiation are definite problems for the patients. These treatments, though warranted in many cases, are to be seriously weighed against the negative aspects. Many times, the strongest treatments do not mean the best treatments.

[Joanne S]

Thanks Lani
I understand and greatly appreciate posts in your own words! :)