Dear LMB3,
At least some of this is likely chemopause.
Firstly - It can take some time to get over the muscle/ bone pain from the chemo and Neulasta and some people get it from the herceptin too, although it is often less intense. Make sure you have pain relief - I found ibuprofen (nurofen, advil ) was enough for me. Warm baths/ showers and exercise can help you get going.
The hot flashes are chemopause. The bladder problems may be too, but you need to be checked by your doctor for infection etc. Because of your age, you may start ovulating again after a few to several months which helps+++. Bladder control problems are very common, but not talked about much.
In the meantime I suggest you ask for vaginal estrogen - it is safe for breast cancer patients despite what it says on the packet insert. Your cancer is ER neg anyway. This is important not only your intimate life but it also helps bladder function. You also need to strengthen your pelvic floor muscles (look up on the net.) Those muscles are critical! Try not to sneeze or laugh! The pads available now at the supermarket are pretty good now.
Also, there are some special machines that some gynecologists or some physical therapists have where you sit on this special chair and electric currents stimulate your pelvic muscles. Sounds bizarre, but it works for the bad cases.
Hot flashes are the pits. I had them constantly from midway through my chemo. The vaginal estrogen is not enough to control them. Mine are diminishing in frequency over time. Wearing layered absorbent (cotton) clothing that you take off as needed helps, as does a swig or two of ice water when you feel on coming. There are a few non-hormonal treatments such as
- Venlafaxine (Effexor, Pristiq)
- Paroxetine (Paxil, Pexeva)
- Fluoxetine (Prozac, Sarafem)
- Gabapentin (Neurontin, Gralise)
You'll only need these if you find the flashes distressing. These therapies work fo some and not others and all have side effects.
I found the sleep disturbance the worst and have a very low dose of Mirtazapine (Remeron) at bed time to help me sleep. This is less addictive than Ativan and doesn't have withdrawal effects. I can cope with the flashes during the day now.
Good luck with this.
Aussie Girl