Chemotherapy Induced Peripheral Neuropathy (The Return of Side Eff@cks)

Leah 0:00

Welcome to episode 35 of the cancer pod. Join us as we talk about chemotherapy induced peripheral neuropathy from a naturopathic perspective, and from the perspective of a naturopathic doctor who has chemotherapy induced peripheral neuropathy. This is one you're not gonna wanna miss.

Tina 0:18

I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah 0:22

and I'm Dr Leah Sherman and on the cancer inside

Tina 0:25

And we're two naturopathic doctors who practice integrative cancer care

Leah 0:30

But we're not your doctors

Tina 0:32

This is for education entertainment and informational purposes only

Leah 0:36

do not apply any of this information without first speaking to your doctor

Tina 0:40

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah 0:47

Welcome to the cancer pod

Here we go...again!

Tina 1:04

Hey, Tina. Hi Leia. So we're back here. We are again,

Leah 1:09

like not like, oh, we're just back with a new episode. We're back with the same episode that we

Tina 1:14

just recorded. yeah, because the first one mincing, no words really sucked. Oh my God. We were so boring. if we were having a conversation like at a restaurant over dinner and we sounded like we did in our first take on this neuropathy, I would've left. cause we were really, really boring. Yeah, it

Leah 1:34

was, I don't know what was going on, but, um, Chemotherapy induced peripheral neuropathy is such a huge subject and it's so important. And I know people wanna know more about it and yeah, they would've just shut us off. They'd be like, no, I'll live with it. I will just live with the neuropathy. this podcast is more painful. and my

Tina 1:56

neuropathy. Absolutely. Okay. And the irony is I have written on this topic since 2010. Like I have lectured on it. I've written on it. You know, I know it inside, out, up and down it from an academic and like a clinical perspective. And I still couldn't pull out anything interesting to say, Hey, and I've lived with it since 2014. maybe it was just a bad day altogether. It was a bad day. Okay. So let's

Leah's experience with CIPN

Tina 2:20

do this. Let's just start Leah Sherman with you. We're gonna start with you. One of tens of thousands of people out there who still have some peripheral neuropathy post chemotherapy. So I wanna ask. On a day to day basis. What is it like to experience this?

Leah 2:40

So some days it's okay. And then some days it really acts up. So what I initially experienced and what I experienced now is way different. My initial experience was the day I woke up after getting my paclitaxel treatment slash reaction. I had burning on my palms and on my feet I had.

Tina 3:05

These shooting radiating

Leah 3:09

migrating pains in my legs. I mean, it was just crazy. Cuz I had handled the first part of my chemo, the AC I had handled it so well that everyone assumed, oh, you're gonna fly through the Taxol. Well, Taxol hit me like a Mac truck. And I just feel like everything kind of went down from there. I mean I switched to Abraxane mm-hmm and all of those side effects continued. I had, um, the sensation of my fingers had been crushed in car doors. Those migrating pains that I mentioned. I mean, those were just. Incapacitating that I had to take an extra day off following chemo from work, cuz I just couldn't. I couldn't walk. There was no way I could drive it. It got pretty bad and acupuncture is what saved me. I guess we'll go more into like what, what helps, but I'm just gonna put that out there in case we forget to mention it, which I don't know why, because it is my favorite thing to recommend. But now what I experience, I guess for like a couple of years following the end of my chemo, like I couldn't wear high heels

Tina 4:14

or really like too tight of a shoe mm-hmm I had this

Leah 4:19

thing where my feet were kind of numb, but if you stubbed your toe or stepped on something, it was like this crazy magnified pain Uhhuh Like the pain was like insane. I think of it like as like a Lego, like you step on a Lego and without neuropathy. And you're like, that hurts a lot more than you'd think a small little plastic cube would hurt. It was like that magnified. Oh. And I also had the numbness around my mouth mm-hmm which was so bizarre. And finally, I guess I just was far enough away that it started to really be where I didn't notice it all the time. And then every once in a while it flares up mm-hmm so it's, it's like the tingling, the numbness, a feeling of my, my feet are kind of slightly swollen, but they don't

Tina 5:11

really look swollen.

What went awry to increase risk of CIPN?

Tina 5:13

Now, I'm just gonna say it here now, because often we're offering people, things that will prevent these side effects. We think in retrospect, at this point that some of this was exacerbated by the constipation that you experienced

Leah 5:27

you and I have talked about this, like quite a bit where I thought I was doing myself a favor by plugging myself up. Cause I didn't want diarrhea because I had to drive 30 minutes each way, you know, to work, um, and work. And yeah, I'm wondering if just by keeping all of that inside of me, mm-hmm for like five days mm-hmm did didn't contribute to the worsening because I did everything naturopathic. Yes. To reduce my risk of neuropathy, which we're gonna talk about too, of all of the potential things that work with patients, but it didn't work with me.

Tina 6:01

So. But we think that we at least theorize at this point that that's probably the case because the constipation can lead to having a higher level of the actual chemotherapeutic circulating because you're not releasing it in your stool at the proper rate or at the expected rate. So you might actually get a bigger dose than you otherwise would get, which could make the neuropathy or any side effects more severe. So that's what our premise is at this point, because you did do everything one could do as a naturopath. Right. Other than stay regular, right? Yeah.

Leah 6:34

Yeah. So, okay. So peripheral neuropathy, like what,

What is Chemotherapy Induced Peripheral Neuropathy(CIPN)?

Leah 6:38

what is it and why does it happen? So it's, it's nerve damage that happens as an effect of getting chemotherapy mm-hmm and depending on the chemo, it affects different parts of the nervous system. or the peripheral nervous system, I should say.

Tina 6:58

Yeah. So as far as chemotherapy induced, peripheral neuropathy, the drugs themselves, and there's a whole list of drugs that can cause this as a side effect, they affect the nervous system in different places. So some might be at the very ends of your fingertips, you know, right there at what are called the C fibers. There could be damage. There could be damage right in the spine where there's a, what's called a synapse where one nerve talks to the next nerve that goes up to your brain and that would be other drugs. So we can put that on our website, um, and a nice picture, a diagram to tell people where it's happening in the end. It feels similar though. It doesn't matter where it happened. Like your description is what people experience, whether it's the numbness, the tingling, or downright pain, if it's severe enough, um, peripheral neuropathy presents to the patient. Similarly, no matter how the mechanism happens,

Leah 7:48

but the same drug can present differently to different people. Yes. which is just wild. And what, what I found really fascinating was I found myself repeating the way things were described to me by patients. I naturally just said, oh yeah, my fingertips feel like they were Christian, you know, car doors. And then I was like, whoa, I've had patients say that to me before. This is what they felt. And I remember at the time hearing them say that thinking, oh, that's so unusual. I've never heard anyone else say that. Mm-hmm So it's, it is interesting to hear how people describe because it, it can be very individual. It does tend to be bilateral mm-hmm So it'll be both hands, both feet, that kind of thing. Um, and it often starts at the very tips of your fingers and then starts to come up your hands sometimes to the, you know, pass the wrists and the same thing with your feet. Right. It starts with the toes and it starts to kind of CLU climb up in that sort of, that stocking glove distribution

Tina 8:51

yeah. So this is, uh, very specific. So we're just talking about chemotherapy induced peripheral neuropathy today, and it's similar with some other drugs. There are other drugs out there that can cause this

Leah 9:02

Right? And it can be exacerbated if certain medications are being taken, or if there are certain conditions that, people came into mm-hmm chemotherapy with

Tina 9:14

yes. Predisposing them. Mm-hmm

Leah 9:17

so an another part of it is, you know, it's not only the sensation of numbness, tingling, pain burning, but, there could be altered sense in like tempera. People can experience

A variety of symptoms

Leah 9:32

just like an overall, like weakness in their legs and arms. you can have problems with balance. And then as I mentioned, there could be other organ systems that are affected, like your gastrointestinal system. Sometimes it feels like food just isn't moving along the digestive track. Um, and then there can be urinary issues

Tina 9:54

too. Yeah. Yeah. I mean, you really do start to appreciate the integration of the nervous system with every function in your body. So every muscle has to be integrated. Every sensory nerve plays a part. So it's, it's kind of interesting to think about how much can be. Affected by this one side effect and, for every person it's different, you know, this goes back to, you know, if someone has a side effect report it, if something is unusual, report it, if your lips are numb, report it, if you yeah. Are hearing something in your ears, report it, like just jot it down between visits and report every symptom, because it may seem odd, unusual, or kind of freaky even, but it might make sense to the doctor. It may add

Leah 10:35

up. Right. Cause you mentioned gearing. So yeah, you could have hearing changes and vision changes too. Really any part of you that's innovated potentially can be affected by the chemotherapy. So let's do a quick little break and then we'll come back. We'll talk about conditions that predispose people to C I P N and we'll do a quick list of some of the more known drugs that affect the nerve. So let's just kind of quickly run through some of the drugs or at least the categories

Some chemo drugs that can cause CIPN

Leah 11:05

of drugs that can cause chemotherapy induced, peripheral neuropathy. So the big ones that people hear about are the platinums, the tax and the VECA alkaloids. Mm-hmm there are others which will put in our show notes, but these are like the big three. Yep. Probably because they're used most frequently. Taxings and platinums are often used together. So that's

Tina 11:31

like a double whammy. Yeah. So I think it is frequency of use and they do have different mechanisms. So when someone is getting a platinum and a taxine those two classes of drugs, which is often used in something like ovarian cancer, um, several other cancers as well, but ovarian comes to mind. There are two different mechanisms of neurotoxicity. So you are getting a true double whammy. Like you're getting it from a couple different angles. So nearly everyone has some level of neuropathy. If they get that combination and we stave it off and then do our best to repair the nerves after treatment. And a lot of our work from an integrative medicine perspective takes place afterwards, so that we stay out of the way of the actual treatment. Right.

The concern with any agent that lessens a side effect

Leah 12:12

Cause the concern is that if you are taking something during treatment, is it interacting with the treatment itself?

Tina 12:21

Yes. The, and then the assumption is if you lower a side effect. then. Yeah, you can assume it's interacting with the treatment unless you've been proven otherwise, or unless the risk benefit weighs out so that you should use it. So, so we're gonna talk about that next and which natural supplements and integrative medicine is used alongside some of these agents. but everything is a risk benefit. You weigh the risk and the benefit of everything. And that's true of the conventional side and the natural side. So it's no different. So when we get to it, we'll talk about why we think some things are worth

Some conditions that raise the risk of CIPN

Tina 12:54

the

Leah 12:54

risk. And sometimes like, like we've mentioned, like patients come into treatment, either taking a medication or having some sort of predisposing, you know, condition like diabetes is a huge one because diabetes already puts a person at risk. If they have uncontrolled blood sugar, mm-hmm, they're at a higher risk. Without chemotherapy of having neuropathy. There are some nutritional deficiencies that the big one I think about is when someone has B12 deficiency, but then at the same time, you don't wanna, willy-nilly take a B12 supplement to prevent neuropathy because that might not be the issue or the concern, right? Unless you have pernicious anemia,

Tina 13:33

right? So this goes back to making sure you have enough of every nutrient, which is repletion, which is very different than depletion. So if you're depleted in B12, then you have a deficiency then that can present as a neuropathy all by itself. But if you're replated which is a new word for a lot of people, repletion just means you have enough of it. You're not taking mega doses. You're just making sure you have an adequate amount is repletion. So that's what we try to make sure everyone has, Something

Leah 14:00

else that can deplete B12 is if somebody has a history of alcohol abuse, mm-hmm I mean, it can, it can deplete several B vitamins. Um, other medications like Metformin, um, having thyroid conditions can lead to neuropathy something physical. Like if somebody has, thoracic outlet syndrome or carpal tunnel, mm-hmm it's not that the chemotherapy is going to necessarily worsen that it's just, it it's like a confounding factor.

Tina 14:34

Right. They have what would be a, more of a compression of the nerve, like in carpal tunnel. And then if there's a toxicity to the nerve on top of it, it's an additive thing. So that you're adding two different types of neuropathy together, which could result in symptoms sooner.

Leah 14:47

Yeah. And then age, age itself. So, and that might be a part of just, uh, having a different metabolism of the drug mm-hmm or just nutrient deficiencies that can happen as people

Tina 14:59

get older. Yeah. Yeah. And you mentioned the B12 and then there's the B one of alcoholism and also B6. So yeah. As people get older, they just don't absorb them as well. Sometimes. Yeah.

What can reduce your risk of CIPN?

Leah 15:12

So, so what can be done to reduce the risk? If you look up in ASCO, they're gonna say

Tina 15:20

nothing pretty much nothing in, in the ASCO stands for the American society of clinical oncology. And we should put a little posting on our website of their recommendations and maybe a little caption as to why we don't go by them in this scenario, because basically they say don't do anything, right. No exercise even.

Leah 15:42

Oh, interesting. Well, but do they say things like, like. Don't smoke limit alcohol control, blood sugar levels. Keep your bowels moving. Do they say any of that? Cause those are things that are recommended in other, in other sites. Yes. I mean like websites, I mean like other resources.

Tina 16:00

Yes. I think that they are clear about just keeping up regular bowel movements, but, um, it's really they actually say they're against a lot of the things that very selectively can be helpful. So for example, I'll give you an example, vitamin E they're, moderately against anyone taking vitamin E the level or strength of the evidence they call intermediate. And the benefits for vitamin E are low and the harm's low. So they, they see the D assess the risk benefit as low on both sides. So don't bother. So they're gonna say, don't take it now. Vitamin E doesn't work across the board. It's true. I mean, there's, that's what the headlines of the actual published papers say, vitamin E does not work for chemotherapy induced peripheral neuropathy, but if you go through the data, you can see vitamin E does work for one particular drug. Um, Vitamin E has good evidence against certain drugs. That's the platinum drugs assist platinum carboplatinum in particular. So that's the only time it may be worth taking. It may not be worth taking for. Chemos it's the strongest evidence is by far with those drugs. So my point with ASCO is they make a blanket statement on the vitamin E for all chemos on here in this paper that we're gonna put up, but it's hard to do any blanket statement for any natural agent and say peripheral neuropathy because there's different causes. And so you have to match the, and they're. Yeah. Right,

Leah 17:18

right. And they're different drugs. So, and like with, um, what you're saying with the platinums and vitamin E isn't

Platinum chemo and vitamin E

Leah 17:24

that because the platinums may cause a vitamin E deficiency. Yeah.

Tina 17:29

So interestingly, yeah, we don't know if this is because it's actually having come some kind of nice amelioration of the symptoms or is it just because the platinums may be causing a vitamin E deficiency and we're preventing that from happening by having someone take vitamin. That's unclear right now, but peripheral neuropathy induced by vitamin E deficiency looks a lot like peripheral neuropathy from a platinum drug.

Leah 17:52

And I should say like, that's where a lot of both the conventional ways of addressing chemotherapy induced, peripheral neuropathy, as well as the integrative slash naturopathic approaches, they're kind of taking it from other causes of neuropathy. So it's like, well, this drug is prescribed for diabetic neuropathy. And so let's try it for chemotherapy induced. And we kind of do the same thing with how we are addressing neuropathy with natural agents. It's it's that same sort of like if it's not due to a blatant deficiency, then it's, well, we use this substance for diabetic neuropathy, so let's see how it works with chemo. Yes.

Tina 18:33

That's often been done. Mm-hmm and so there is evidence, so just let's be clear. There are published. Papers on this topic. This is not just kind of connecting the dots. There are actually publications saying when people took vitamin E during the time that they received, you know, a cisplatin or carboplatin, they had less neuropathy. So I wanna be super clear about this because we're not, you know, we're not connecting dots ourselves. We're just going by. What's actually been published from clinical literature. Yeah. And I wanna say one last thing, cuz this is, is often a question. ASCO has a different bar of evidence that they will use and it might be a higher bar. I will admit that all di all day long, um, we often will put this through the, is there a reason not to take the vitamin E that may be helpful for someone to prevent peripheral neuropathy? If there's no reasons to not take it and it may be helpful, then it seems worth it. Cuz it's very inexpensive and it's, there's no risk to it that has ever been seen or proven, or that we know

Leah 19:30

of, not the dosages that we would recommend. I mean, if you do super high doses of vitamin E you run into a. Risk of something happening mm-hmm which we will get into. And the next part,

How ASCO falls short in their recommendations

Leah 19:44

but

Tina 19:44

well, and I wanna say, cuz we're going against ASCO, which is, you know, this is a giant group of experts who know medical oncology, unlike anyone else, cuz they are the go-to group. And for us to talk and say, we don't really take their guidelines at face value. We do something a little different. I think we need to justify that up. The Wazo so the reason I'm saying this is they also don't recommend on their recommendation list. They do not recommend Gabapentin. So it's not just natural agents

Leah 20:14

right, right, right. It's it's medications and they don't recommend any, um, of the SSRIs other than, um, Cymbalta deoxidine. So like, that's the only one that is recommended. Don't try anything else.

Tina 20:26

Yeah. So the, the level of recommendation here is so tight, the, the standard is so tight that they don't even recommend what is commonly used standard of practices to use the SSRIs or to use the Gabapentin.

Leah 20:38

Yeah. Or, cryotherapy. Right. Um, cryotherapy, you go into cancer centers and patients are icing their, their hands and their feet, whether they're wearing gloves and booties, or they're just, you know, got the ice in a plastic bag. Yeah. I mean, patients are, are doing this cancer centers are offering. Services to people and that's, it's not a, it's not a guideline through

Tina 21:02

ASCO. No, no. So the ASCO recommendations are so tight that it's practically nothing is recommended and that doesn't seem reasonable when you're given the risk benefit of lifetime neuropathy and someone who's getting, you know, a, a treatment where it's likely to cause neuropathy. I mean, doesn't make sense to me. Right. And you

Leah 21:24

know, and it's a curative treatment, right. I mean, it's like the goal it's curative intent and you're left with this lifelong yeah. You know, symptoms,

Cryotherapy = Fancy word for ice

Leah 21:34

so, okay. Let's go back to cryotherapy. So cryotherapy has been studied with taxanes.

Tina 21:41

Wait, I don't know if people know what cryotherapy is. Oh,

Leah 21:45

ice cryotherapy is ice,

Tina 21:49

ice, ice, baby.

Leah 21:50

It's the use of ice as therapy cryotherapy. So

Tina 21:54

it and good old ice. not, not liquid nitrogen.

Leah 21:58

We're not trying to cause problems here. Um, but you have to be careful with cryotherapy too, cuz you can't leave the ice on for too long because you don't wanna. Cause frostbite mm-hmm so

No ice with oxaliplatin!

Leah 22:08

yes, the use of ice during an infusion to reduce the risk of peripheral neuropathy has been looked at with paclitaxel

Tina 22:18

mm-hmm I think the most,

Leah 22:20

yeah, the most. Yeah. So the one that it is contraindicated with would be oxaliplatin with good reason, which is a, it's a chemotherapy that is used in, um, like colon cancer and pancreatic cancer. And it can cause a side effect, which is a neuropathy of just this cold

Tina 22:46

sensitivity. Yeah. You basically get zapped by anything cold. It's like a, it's like a zap, but like a really strong zap when you grab something that's cold, even outta the refrigerator sometimes.

Leah 22:56

Right. And you're. Warned about drinking anything cold because your throat can spasm and it can feel like you're choking, which you're not, but it's just that, that cold reaction. And it usually lasts for about three days after the infusion, often starting during the infusion. I mean, I had patients who, before they even like got their infusion of ox plan or eating ice cream, cuz they're like, I can't have ice cream for three days. and so they're sitting in the infusion room, eating something cold, like

Tina 23:25

challenging, you know, like that's, I'm gonna

Leah 23:26

beat this. I'm gonna get my ice cream in before. Yeah, no, I haven't had more than one patient do that. Um, or drinking their, their cold drink because they don't like room temperature, um, water or whatever. So I did find a study from a couple of years ago, looking at the use of ice therapy or cryotherapy during oxaliplatin to see if it reduced that very sensitivity. And it, it sounded like torture. I think so much that like a third of the, the patients dropped out

Tina 24:02

of the study, I'm surprised it was only a third. Yeah, yeah. Yeah. Well, and yeah, that seems like it shouldn't even have really passed any ethical review board. Cuz the idea of giving someone who's getting Oxil platinum,

Exercise?

Tina 24:15

putting their extremities on ice of any kind seems like that's asking for trouble. That doesn't seem right.

Leah 24:22

Yeah. That, that doesn't seem, um, seem right at all. something else that I have found, I guess more recently in the news is in the news in the medical circles is exercise. exercise is being promoted as a way to reduce your

Tina 24:44

risk. Mm-hmm that makes sense. I mean just in the, in the idea of good circulation and any tissue that is healing, because while your nerves are being assaulted by the chemotherapy, they are also always trying to heal like any tissue in your body. After you get damaged, your body automatically goes into trying to heal the tissue that's been damaged. So on that note seems like anything that increases circulation should increase the healing potential.

Leah 25:09

So that seems like a very kind of low risk thing to try to, to reduce neuropathy. I mean, it's low risk as long as you're not having issues with balance, which can happen with neuropathy, you know? Yeah. And again, this is gonna be kind of in the recommendations, section of this podcast, but I am a huge proponent of. People seeing occupational therapy and physical therapy, especially when it comes to peripheral neuropathy, because they can offer tips. Occupational therapy helps with those kind of day to day. Situations mm-hmm physical therapy can provide exercises and make sure that you're being safe. Maybe you do need a Walker. I know I encountered that with my mom where, you know, there was a certain amount of pride with using a Walker mm-hmm But when she realized that, you know, she had such weakness from going through treatment and the neuropathy, the Walker could substitute as a little seat. You put on the breaks, you sit down. Yep. She used it to carry her purse. She loved it to carry her purse.

Tina 26:21

I've seen people put coffee cups on them, like put a coffee cup holder on it. Oh

Leah 26:25

sure. And I think we originally got her a cane thinking that would help. And when she saw the physical therapist, they're like, no, no, no, no. Cane is not appropriate for her. This is what she needs. Mm-hmm you know, so it's just kind of, and, and what kind of cane do you get if you get a cane? So just taking that off of your plate and going.

Neurostimulation

Leah 26:43

Directly to a physical therapist, as well as an occupational therapist to help mm-hmm I guess we don't have to address this in the next section cuz we're addressing it now, but I do think that is really, really important. and there are things that they can provide that isn't something you can do at home, like neuro stimulation, you know, getting a, a tens unit mm-hmm which is the rebuild. Um, what's the other thing that the scrambler mm-hmm is another name for one of these kind of devices that stimulate your nerves.

Tina 27:16

so I was just gonna say, each of those is an electrical stimulation mm-hmm that either interferes with pain from the nerve or helps regenerate the nerve is the idea of it. Right. Just in case people didn't know what neuro stimulation

Leah 27:29

was. Oh yeah. Yeah, no, but I think it is good to bring that up now just because the way I don't wanna leave out acupuncture. I don't wanna leave out physical and occupational therapy. Yeah,

Tina 27:39

I totally

Topical agents for neuroapthy

Tina 27:40

agree.

Leah 27:40

um, we already mentioned like the conventional drugs, right? The anti-convulsants like, Gabapentin mm-hmm and the one SSRI, you know, Dine or Cymbalta. Uh, there are some topical drugs that have been looked at, which I used, when I was down in, in Arizona as we had a compounding pharmacy. And so that was really nice to be able to use some of these drugs, which can cause side effects like drowsiness, like Gabapentin using it, topically mixed with other drugs like Baclofen, um, ketamine was another topical drug that, would get compounded. I remember when I first started working down there and wasn't quite familiar with these compounded formulas, there was a very popular formula, including lidocane mm-hmm which I eagerly prescribed for a patient who was experiencing not only like neuropathic pain, but also had numbness and he slathered this lidocane compounded cream on his feet and his feet went, they became more numb. Yeah, which was not really the result that we were looking for. So, um, yeah, not all of these topicals work

Tina 28:52

for everybody. Well, and it's all relative. Right. So if he had pain, if he had painful neuropathy, he would've welcomed the numbness.

Leah 28:59

Right. But pain and numbness.

Tina 29:02

Yeah. So you, if you were numbing the pain, that would be awesome. But, um, yeah, doesn't numbing your feet is probably not ideal cuz then, right, right.

Leah 29:09

I mean that formula was probably better for somebody who had, a postsurgical kind of neuropathic pain. Right. And you would apply it to, you know, your chest or some, you know, your arm or wherever the surgery had been, but yeah. Applying it to your feet was, um, yeah, that, wasn't one of my finest moments, but using things like menthol, that's really nice. because menthol kind of tricks your nerves into not recognizing the pain.

Tina 29:37

Yes. Just like icy hot. Yeah. Most people are familiar with Ben gay or icy hot or some of these over the counter, you know, they also use it for muscle relaxants in that case. But that also interferes with yeah. Pain

Leah 29:48

signals. Yeah. That's something that I would have patients try at home, whether it was just using VIX, vapor rub, which a lot of people tend to have at home. You know, mm-hmm, you can try applying that to your hands or your feet or icy hot. It's not something that is going to change or reverse. Right. The neuropathy it's just gonna help manage the symptom, especially at night, you know,

Why are symptoms often worse at night?

Leah 30:11

because that's when you feel it really the most is when you're kinda laying still, at least for myself and many patients is yeah. You're, you're laying in bed and it just becomes even more noticeable.

Tina 30:22

Mm-hmm. A lot of things get worse at night. So any symptoms you have can be worse at night that could be itching

Inflammation and neuropathy

Tina 30:30

on the skin. It could be aches and pains. It could be, um, neuropathy in this case, but your cortisol is so low in the night. You don't have that natural anti-inflammatory effect that cortisol gives you during the daytime. Oh yeah. Did

Leah 30:42

we even mention that those pro-inflammatory cytokines may also be, you know, that's, what's being implicated as one of the causes of this sort of neurotoxicity. I don't even think we, we covered that

Tina 30:55

part of neuropathy. Part of it is due to continuing inflammation. So this is systemic inflammation. This is also considered neuroinflammation. So just as a global effect, if you're inflamed systemically, if you are in an inflamed state, meaning there's more of these cytokines in circulation, wherever you are feeling. Inflammatory reactions are gonna act up. That could be osteoarthritis. It could be neuropathy. If you have neuropathy from chemo in the past, it could be a skin condition like eczema. So

Delayed CIPN?

Tina 31:28

systemic inflammation will present itself to you as symptoms, wherever your vulnerability is. In this case, it could be post chemotherapy neuropathy.

Leah 31:38

And a really interesting thing that can happen is someone can, I don't wanna say sail through, but somebody can go through their courses of treatment. Totally fine. No neuropathy. And you mentioned that you have seen where later the patient says I have neuropathy. Now what happened?

Tina 32:02

Yeah, it's puzzled me. The, my entire career they'll end like Taxol in a platinum drug. You're like this, person's probably gonna get neuropathy. They go through, they finish treatment with no neuropathy. And then three months, four months later, they like I'm having neuropathy and you called it what again?

Leah 32:18

Well, coasting was a term that I had encountered

Tina 32:22

Yeah. Like late onset neuropathy. It's really unusual. And I don't have any great explanation for it to be honest. I mean, I've definitely seen it in patients. It's unusual, but it can happen. And I I've always been a little bit baffled by it. Yeah.

Leah 32:36

Well, I like mentioning the unusual because there's probably at least one person out there going, oh my gosh, that's me. Yeah. You're not alone. Yeah. I, I like people to know that. Yeah, you're not alone that there is somebody out there. It may not be common, but it can happen. Mm-hmm so anything else we wanna cover in this section? Or should we do another little

Tina 32:55

break? I say we do a break and then we come back and talk about some natural agents and which ones

Natural agents for CIPN

Tina 33:00

are appropriate when

Leah 33:10

All right. We are back and we are gonna cover some of the integrative therapies that are used to reduce the risk as well as to treat chemotherapy induced, peripheral neuropathy. So I think what maybe what might be easier is if we kind of talk about one of these therapies and we can cover the indications as well as the

Tina 33:32

contraindications. Yeah, that sounds good.

Leah 33:34

Yeah. So we don't have to come back. We'll just cover

Tina 33:37

it all. And as I mentioned, We like to be really specific. Like you take this natural agent with this particular chemotherapy or this other natural agent and don't bother with others. So this is not a shotgun approach. This is very specific approach using the evidence that we have to date.

Leah 33:56

following treatment, there is a little bit more wiggle room with some things I'll give you that. But yeah, I mean, there, there are certain agents that we would never use once treatment has ended, but then there's some that are kind of interchangeable.

Tina 34:10

Yes. And repletion is always okay. Right. So just making sure you're never low. And this is diet. When you talk about repletion, I'm usually saying diet, unless there's an issue with absorption of a nutrient. Yeah.

Leah 34:23

And we haven't actually said that yet, which is interesting. Cuz usually when we start talking about repletion, we're like food first. So this is the first time we're saying it in this episode. Food first repletion. Yes.

Tina 34:34

Repletion. Make sure you're not exacerbating your neuropathy by being deficient and B vitamins like B one B6 B12. So make sure you're eating well, eating whole foods and real foods. I, I don't wanna put, I'm gonna say real food over whole food, even because now there's all this fake food out there. You know, that claims to be healthy, but it's not healthy. It's just fake. It's processed food. That's organic. It's not healthy. That's like a whole new

L-Glutamine

Tina 35:00

episode. I know. I'm just saying that because when we say eat well, we're not very, we don't qualify that with what we mean. So real food and whole

Leah 35:06

food. Right?

Tina 35:07

Let's let's start with one that's misused, even in our own circles.

Leah 35:10

Oh, my gosh. I know which one you're talking about. Glutamine. Yeah. Glutamine. Yeah. It's glutamine. Yeah. Glutamine L glutamine has been studied and there were mixed results in the studies. Some were favorable. Some did not show any benefit. Um, but it was very specific as to which chemotherapies it was used with. And depending on the chemotherapy, it depended on how long it was being used in terms of like, like days and, and whatnot.

Tina 35:42

Right. So the first one out of the gates was what is back in 1999, 2000 was 30 grams. That's three 0.0 grams per day of LG glutamine for four days. Beginning 24 hours after taking a taxane drug. So that's paclitaxel and docetaxel, taxa, or Taxol. If you wanna know the name brands, at least, um, at that time, those were the only two available. The study looked at taking that really high dose. 30 grams is a powder. That's a ridiculous number of capsules. So yeah, generally it's a powder and it starts 24 hours after your infusion stops and you continue it for four days straight and then you stop taking it. That's how it was used in the study. And it showed that the lessened. Aches and pains, peripheral neuropathy. A lot of the things that you described earlier in this episode, those things that you experienced, it lessens a lot of those neuropathy side effects of that whole family taxing family of, and we're

Leah 36:39

going to actually devote an entire episode to glutamine, but just quickly, L glutamine is it's an amino acid and it is the most abundant found in the body. Mm-hmm I like how you nod before you say before you say anything, I'm like, dude,

Tina 36:57

this is a podcast

Leah 37:02

nodding and I'm like,

Tina 37:04

Say something. Well, that's funny because I'm probably hearing you say something and finally I say something cuz I would otherwise I'm just nodding. Yeah. Uh, yeah, you're just nodding. I don't wanna tell you how many Yas I take out of this when I edit

Leah 37:17

all right, so it's okay. So, so glutamine, yes. Abundant throughout the entire body, all of our cells use it. We're gonna talk more about it in a specific episode, a special episode. What are you

Tina 37:30

looking at? I have a poster of all the, all the amino acids on my wall and I was just looking at the structure of glutamine.

Leah 37:36

I thought you were looking out the window. I was like what? She got like a

Tina 37:39

squirrel out there. It is next to my window. That's funny that you say that? No.

Leah 37:42

Okay. So L-glutamine is very specifically used with the taxanes and the platinums.

Tina 37:49

Yes. In high dose,

Leah 37:51

in high dose. The times that it is not used would be in patients with pancreatic cancer. and after treatment is over

Tina 38:04

in high dose in high dose so I'm gonna, I'm gonna, I'm gonna explain the qualification of in high dose thing, because they did the 30 grams. If you only do a small amount, you do 500 milligrams, a thousand milligrams, you know, you take a capsule and you're doing it for your GI tract, because we often give glutamine for the lining of the entire GI tract for its health, because it's a preferred fuel source for those cells. So your small intestine cells, especially, and your upper small intestines, they like to use glutamine as their fuel source, right? They like they'll take in the glutamine and they'll break it down and they'll use it for their own health. So we use it to heal the gut a lot. And in those lower doses, I think it's perfectly safe because it doesn't get past those cells. Those cells take it up and it never sees the bloodstream. In that case, cuz the intestinal cells are using it avidly. So the large doses are, is used in order to bump the bloodstream up because you saturate the small intestinal cells. They, they take in all they need and then there's extra. So that flows into the bloodstream. So when we say don't take it afterwards, we mean large

Leah 39:10

doses, the yeah, the large doses, the 15 grams twice a day or the 10 grams three times a day. Yeah.

Tina 39:16

It's not gonna help.

Leah 39:18

Right. There's no, evidence at all. I don't even know if it has been looked at, but it's not something that,

Tina 39:24

that somebody should take. There's not even a reason in theory that ultra high doses of ALG glutamine post chemotherapy is gonna have an effect on your nerves. Like there's nothing that I can think of. And the reason that we're are downright against doing it is glutamine is taken up by tumors, avidly as well. So. It's only second to glucose as far as a fuel source that cancers in general, like to use. So we are really cautious about that. Like if a cancer cell likes it, then we tend not to wanna give it. Right. And so the reason it's okay for those four days is because the taxane drug

B Vitamins

Tina 40:00

is having its effects. So it's okay. During that time, if the cancer cells are dividing, that's how the taxane works. It needs those cells to be dividing. So if you are giving glutamine while the taxane is in your system, if those cancer cells at all are enjoying that glutamine for their own. Use it's okay. Cuz thetans taken 'em out at the same time, we

Leah 40:22

had a, we had a medical oncologist who worked with a lot of patients with GI cancers. Mm-hmm and he was the one who brought up, not using glutamine with patients with pancreatic cancer because of that reason. Okay. Because of the preferential, um, yeah. Diet of the cancer cells being glucose and glutamine. So that's why, that's why I don't use it with patients. Even though they're getting often they're getting, you know, a, um, a platinum. So, uh, we've already covered B vitamins. I mean that you've got B one, B six, uh, folic acid deficiency and then B12 mm-hmm again, those aren't something necessarily given Willy nilly. I've said Willie nilly twice in this episode. Yeah.

Tina 41:10

What's with the Willie nilly today. I don't know

Leah 41:12

my, my, uh, my vocabulary is very limited today. um, so do you recommend B vitamins? I have. I

Tina 41:22

know I used to. Yeah. You say I have, have pulled back a little bit over, over the last, you know, 20 years, especially. I mean, we used to give B vitamins, wait a second. Wait for it. Willy nilly. Ah,

Leah 41:37

Willy nilly. I feel like that isn't that like the name of a penguin cartoon that's to chili that's

Tina 41:42

chili Willy Oh God, no,

Leah 41:46

we did. No, but we did. Yeah. I mean like in my training and then, you know, my, my early years out of training mm-hmm yeah, there was a product, it was a, a fully free B complex that we would give to patients. I took it myself

Tina 42:01

well, and here's the reason, um, B vitamins are a co-factor. If you want an enzyme in the body to work more efficiently or have more function, you can increase the cofactor in this case, B vitamin Now in the days of orthomolecular medicine, we used a lot of high dose things, including the B vitamins to push these enzyme reactions. And now we have a little more respect for the fact that, you know, cancer is also just another system in the body using the same enzymes for its own purposes. Right? So do we always want to increase particular enzyme systems when the cancer cells themselves are using it and maybe not. I mean, that is why we're more cautious. We just know more now. So we're, we pull back on that whole B vitamins do no harm idea. That's not completely true. We haven't proven that they do no harm at high dose when people have cancer present.

Leah 42:51

I, I will admit that one of the reasons I stopped recommending it. I mean, in addition to what you said, because more information is coming out about. High doses of certain B vitamins may drive certain cancers is just the fact that they smell so incredibly bad. I stored mine in the freezer. I think first I stored it like in the closet with my other supplements and then I'd open my closet. And I was like, oh my gosh, this is so bad. And so then I put it in the fridge and then I moved him to the freezer and I would open the freezer. And it was just like that smell that B vitamin smell when you're going through treatment, you don't wanna smell something like that. And so it was really hard to take. And then, because I wasn't digesting my food appropriately or, you know, adequately, I should say, um, I would just burp it all day long mm-hmm because I was getting a steroid. And so I, you know, my digestive system was wacky. Ugh. I mean, I cut back on how many supplements I recommend to patients. Patients patients

Tina 44:02

those are people, patients, people, patients,

Leah 44:04

uh, no, I cut back on, on the, my recommendations dramatically after going through treatment, because it really is hard. Mm-hmm I mean, I went in all guns, ABL taking all of these supplements, everything possible. And I was like, this is gross. Mm-hmm this is just too much, like things just set in my stomach. It, I didn't feel, I didn't wanna take them. And so I, I started to pair back mm-hmm cause I realized I'm like, I'm like recommending these things to people and they should be eating food.

Tina 44:36

Right, right. So there was that whole idea of people taking their supplements, but not eating. And that was always a bad thing. Yeah. Well, can I, I wanna tell you that with the smell of this stuff makes me nostalgic. So, I, I mean, it's a bummer that you have a reaction probably to this day from B vitamin smell. Oh, it makes me

Leah 44:53

nostalgic too, but not in like, not in like a happy

Acetyl-L-Carnitine

Leah 44:57

nostalgia, way more in a, oh my gosh. Yeah. Was it remind you of like Flintstones?

Tina 45:03

No, although that those were delicious, but no, it, it reminds me of, I did work study in the pharmacology department and they used a lot of Drosophila flies on the floor I worked on and apparently the stuff Drosophila flies eat is a lot of yeast nutrient. And that smells like B vitamin basically. So whenever I smell it, I think of the pharmacology days and my college days. And so it's, yeah, it's a, it's like the polar opposite of your feeling. I'm like, oh, that smells good to me.

Leah 45:34

And I'm like, Hmm, no, I don't want that.

Tina 45:36

Yeah. Yeah. But yeah, there,

Leah 45:38

there are, are several reasons to, to not recommend B vitamins and there are a couple reasons to possibly recommend them. Um, acetyl L carnitine. That was one that also was used quite frequently. Mm-hmm during treatment until the study came out that said that patients who were getting a taxine and taking acetyl El Carine actually had worse neuropathy.

Tina 46:03

Yeah. And I, I did, I pulled that one up just before we started talking today and it was published in late 20 17, 20 18, depending whether you look at electronic or paper version, um, Yeah, acetyl El Carine is a, is one of those things that after treatment is over, I recommend across the board almost like for chemotherapy induced, peripheral neuropathy and repair of the actual nerves, it can interfere with some of the signaling, if it's painful or numbness, it can also, at least in animal studies, it looks like it could help with some of the repair of the actual nerve. Um, but it has to be taken in a really high doses. And so I I'll tell you exactly how I do it because I wanna spare people. If it's not working for them, I don't want them to keep buying it on faith. So I'll start people at a really big dose, like 3000 milligrams a day often I'll do it in a powder. Although the powder tastes disgusting. So,

Leah 46:55

oh, I like it. It's so, oh, you do? Oh, God. See were the opposite. No, see it smells gross to me. It smells what little doesn't smell gross. It smells like vinegar, but it's so tart. It

Tina 47:05

makes me make a face just thinking about it. So

Leah 47:08

gross. I like that tartness. That's funny.

Tina 47:10

Oh, okay. Okay. In any case fifth, I start with 3000 milligrams and then have, 'em take that for one month. And if they see absolutely no effects, then I say, it's probably not gonna be something that you were gonna wanna use at 3000 milligrams after one month, if they have some effect, meaning their neuropathy seems to them to be improved, I'll have them go down to 2000 and see if they can maintain some benefit on 2000. And I usually stop it at 1500, but the dose is always between 1,003 thousand. I just start high because I'm like, well, why would you do it the other direction? There's no, I have never had anyone have any effects. There's no nausea. There's no side effects. It's like, you may as well know in one month, whether this is worth your time and effort or not,

Leah 47:50

do you do it? And you do it in divided doses. Usually

Tina 47:53

twice a day, I try to get 'em to do three times a day, but you know, compliance goes down with every dose. You give someone in a day, so, oh

Leah 48:00

yeah. But people aren't doing people aren't taking the 3000 at once. It's it's.

Tina 48:04

No, and ideally away from other amino acids, but again, there's the ideal and then there's the practical. So it depends what people are able to do.

Leah 48:13

So on an empty stomach, because food has amino

Tina 48:16

acids, it will compete. Yeah. It will compete with amino acids. So you do have to be a little bit careful there, but you know, I also am not, I try not to do go into all those nuances. It's like, if something's gonna work, let's just do it.

Alpha-lipoic acid

Tina 48:28

cause right on a practical note, you're gonna take this for how many years you're gonna be taken for two, four years afterwards while your nerves are healing. And you know, it's not easy to do everything perfectly. So there's always the ideal recommendation or, um, prescription. And then there's the realistic one, right? More practical one.

Leah 48:45

Right. People just trying to, to, to get the supplement in as opposed to, you know, we have those patients who are so regimented and they're great because they're like, this is when I eat. And then this is when I take my supplement and and they're yeah.

Tina 48:59

So organized. So some people are suited for it. Yeah. Some people are, they have no problem doing the ideal and other people are like, if I can't do the ideal, I won't do it at all. And so you have to, like, each patient is a little different. You just compliance is ultimately what you want. Nothing works if you don't comply with the, the prescription drug or otherwise

Leah 49:17

so kind of like writing on the heels of acetyl L carnitine is alpha lipoic acid. And what I think is very interesting is that I have seen integrative providers who aren't NDS recommending alpha lipic acid during chemotherapy. Oh. And yeah. And I just, I was just reading on, you know, there are like these groups for people who practice naturopathic oncology and everyone kind of gets together and talks about different cases or whatever. Somebody had mentioned that there are oncologists where they're practicing, who are. Recommending alpha lipoic acid during chemotherapy too. And we've talked about this before. I mean, we talked about this in the first time we recorded this episode. but it, I mean, that is something I would not recommend because alpha lipic acid is such a, it's such a strong antioxidant.

Tina 50:13

It's it's one of those I avoid during treatment because it certainly increases the production of glutathione and other antioxidant enzyme systems within cells. And that includes cancer cells. And so the idea of giving something that is going to be an internal intracellular antioxidant, those are so powerful and glutathione itself. And so many chemotherapy drugs work on that pathway to give something that is going to undo what the chemotherapy is supposed to be doing, which is oxidize. That cell is so counter to anything like that is completely what we should not be doing. So I'm a huge, like no alpha lipoic acid. And I'm the same note for the same reason. No, N acetyl cystine.

Leah 50:59

So I found a study that was published in 2022 mm-hmm that looked at alpha lipoic acid and paclitaxel induced. Neuropathy as well as do Rubin cardiotoxicity, which, you know, having heart problems after getting IIN slash do Rubin mm-hmm is a big issue too. And I don't recall in the article them talking about like looking at it 10, you know, five years out, 10 years out, 20 years out. So why it might help in the moment? Are they not considering, is there an increased risk of recurrence in these patients? I don't think that it's been studied long enough. Right? Right. But they were using 600 milligrams once a day,

Tina 51:45

just once a day, because I know that former studies had done it 600 milligrams, three times a

Leah 51:49

day. The study was, I think the information was collected between 2019 and 2020, and it was published in 2022, but it was a oral dose of 600 milligrams. Once a

Tina 52:01

day and it did prevent neuropathy.

Leah 52:04

Yeah. There, there was benefit seen.

Tina 52:07

Yeah. This goes back to the what's gonna happen over five, 10 and 20 years for those folks we don't know. So the reason, okay. So I wanna explain this to someone. So I mentioned earlier, we're gonna look at risk benefit and it does take a lot of knowledge of all of these natural agents and the biochemistry of what's going on and how they're working in order to even weigh the risk benefit. Because if you just go by the studies, it's not always giving you the full story. So this looks like, okay, it gave people some benefit. It, it lowered their neuropathy, but at least theoretically it may do so at the cost of interfering with the efficacy of the treatment, because lipoic acid is so reliably a stimulator of the production of glutathione and other. Antioxidant enzyme systems. And just to be clear in a lab, when we take, say cisplatin carboplatin in a lab, we use NAAC and probably could do with lipoic acid too, but it's ity use something that increases glutathione to prove that that's how it's killing the cells. So because glutathione in particular is such a potent way of nullifying, the effects of chemotherapy within a cell. Anything that increases it is kind of a no go in my mind until that is proven to be okay. Cause it's more than a theoretical risk. I feel like we've already proven in animals and in stitches that you can undo chemotherapy with these agents. So why would we go and give it to a human. When, if you extrapolate, it's likely to undo the chemotherapy's therapeutic effects. I don't, the risk benefit doesn't weigh out for me in my mind. That doesn't make sense.

Leah 53:49

Right. I mean, until it's proven

Vitamin E

Leah 53:52

to be absolutely safe, it just doesn't seem to be something that that's worth the risk.

Tina 53:56

Right. And that might be true of other things like vitamin E, but vitamin E doesn't work on the same mechanism. So we talked about vitamin E with a CYS platinum earlier, and that too was proven to lower neuropathy induced by CYS platinum and carboplatinum drugs. But vitamin E does not mechanistically does not increase glutathione in the cell. It, it's not an antioxidant within the cell in the same potency of as our own antioxidant enzyme systems. It is an antioxidant on its own vitamin E but it's not going to have a strong effect like lipic acid has on a cell. So it has to do with these nuances of understanding antioxidants and, and, and understanding the molecular biology on a level that is confusing because literally, you'd have to know molecular biology to, to weigh all the pros and cons all the risks and

Leah 54:42

benefits. So bringing back to vitamin E the big caution that I think of is anybody who has, um, issues regarding bleeding. So taking, you know, but we said it's also not super high doses. I know in order to interfere with cloting vitamin E has to be at a pretty high dose mm-hmm but. For people who are on anti anticoagulant medications, um, warfarin is the big one that I always think of, which I guess it's not so popular anymore because of the other anticoagulants.

Tina 55:13

Yeah. If someone's on those things like Eliquis, you mean? Yeah, those, yeah. So

Leah 55:17

something else that people are cautioned about in terms of bleeding, you know, increasing a bleeding risk, but it may be helpful, reducing the risk or even addressing afterwards. the peripheral neuropathy are omega-3 fatty acids. Mm-hmm Because there's EPA and DHA are the ones that we think of. And so it's that DHA that is supportive to the nerves.

Tina 55:37

Mm-hmm mm-hmm yeah, there was that one small trial that used fish oil in people getting taxing drugs too. It was very small. So it's not really something to hang your hat on, but it did show some benefit in, uh, in one trial alongside the taxane and, and, you know, when it comes to fish oil, I'm not a mega doser. I'm like, what would you get if you ate fish, you know, 1,015 hundred milligrams, total EPA DHA is what you would get when you eat fish. Um, and you do have just make sure that you're also eating well alongside your fish oil to make sure that it doesn't get oxidized.

Leah 56:10

So, yeah. Yeah. And so that's something that, that can be used afterwards too. And it may be better tolerated after treatment because if there is any nausea, mm-hmm, It again, is something that people don't tolerate. I like, a certain brand that has inter

Acupuncture

Leah 56:26

coded capsules. And so they kind of stay together. Um, but the big advice I used to give to my patients is don't chase it with something warm. So if they're having it in the morning, if they, if they're like, oh, I forgot to take my fish oil and they, you know, take it in the morning, don't chase it with a cup of coffee because that will break the capsule apart. I probably talked about that in the omega3 episode. Find I find myself repeating myself, but you may not have listened to the omega three episode. So go out there and, and

Tina 56:50

check it out. Yeah. And since I forget everything that you said, UN intentionally.

Leah 56:56

Intentionally or unintentionally? No

Tina 56:58

intentionally. Cause then we gotta keep our conversations fresh. So how about gonna keep our conversations fresh? If I don't forget everything you've already said,

Leah 57:05

I know it's like, we're not we're we're gonna turn into some old Mary couple where we tell the same stories over and over

Tina 57:10

again. Yeah.

Leah 57:11

all right. And so I mentioned it at the beginning. Um, it is something that I do recommend to patients as they're going through treatment as well as afterwards. and that's acupuncture. Mm-hmm there are Chinese medicine, herbs, like PCM, traditional Chinese medicine, herbs and herbal formulas. I know that when patients have seen acupuncturists outside of the cancer center setting, that they're. Acupuncture providers will recommend for them. And I know there's some studies showing that there may or may not be benefit. I, I steer them away from them. I don't know enough about Chinese medicine to, to say yes, there is no potential for interaction mm-hmm so,

Tina 57:51

yeah, maybe after and you know, yeah. I have so much respect for all of the Eastern medicine and traditional medicines that I feel like people who practice that medicine practice it in the traditional sense of the culture, which means they have to assess that person to make it an individual treatment. Right. So even neuropathy's not gonna present the same across the board for everybody. It's a constitutional thing.

Leah 58:16

Oh, absolutely. Yeah. And I think that, you know, there are definitely integrative providers who are also acupuncturists who work in oncology settings and that probably would have more familiarity with the chemotherapies, the treatments that are being used. And so, you know, they, they may know more of the evidence out there in terms of if there's potential for interaction mm-hmm but yes, it's definitely, it's not like this one formula is for everybody because of the fact that they are taking into account, you know, so many of the individual features of, of a, of a side effect.

Tina 58:51

Yeah. Western medicine in general is. Based on symptom and then treatment, rather than looking at the entire person, making an assessment and the nuances of the presentation, like how it presents. When is it worse? When is it better? You know, what does it feel like? Is it connected to any digestive symptoms? Like the entire person is taken into account in traditional medicine, many traditional medicines, whether it's ive or Chinese medicine or Tibetan medicine, or, you know, go on and on around the planet. the whole person is taken into account. So I often will just refer to people who are practicing, traditional medicine

Cannabinoids (CBD)

Tina 59:28

to do that whole thing. Instead of giving someone a. You know, cause some people, some people come to me and like, do you think this is gonna work? And it's a traditional Chinese medicine formulation of a bunch of Chinese medicine herbs that I don't have any knowledge of how to apply anymore. We learned it in school briefly, but I'm not that never, that never stuck. So I just tell them if that's what you're interested in, here's a few names to go see.

Leah 59:48

I would make sure that they definitely have, you know, a strong oncology background mm-hmm so there are other therapies that have been looked at that I haven't really had a ton of experience with, um, the low level light therapy. Mm-hmm cold laser, which I think of for more than more pain. Me too. Yes. Pain, you know, can be part of neuropathy. So you. that might be helpful there. Biofeedback is something that you always see mm-hmm being mentioned. And then I know there are studies looking at cannabinoids mm-hmm Canna, you know, CBD products. Yes. And neuropathy. I have not seen a lot of benefit with that. Actual, you know, the numbness and tingling. I've heard patients say it can help them with, with pain.

Tina 1:00:35

That makes sense. Yeah. But

Leah 1:00:37

the, you know, the pins and needles kind of part of it. I, I, haven't seen a, a huge amount of success, but, you know, I, haven't seen a huge amount of people who are, are using it. Um, I've probably had more people use topicals. Yes. Because there is always a potential for anything herbal to interfere with medications. And

Tina 1:00:53

so on that note, in a future podcast, we're gonna go into depth on the cannabinoids, on medical marijuana, So we're gonna have a whole discussion. Yeah. But we're gonna have experts.

Leah 1:01:03

Yeah. Yeah. Not us just be asking questions.

Tina 1:01:05

Right. Right.

Yoga Toes/ Happy Feet Socks

Tina 1:01:06

With people who know this stuff much, much more in depth in detail than we know.

Leah 1:01:09

Oh, absolutely. Yeah. So yeah, we can see, and again, everybody is different on how they react to, to cannabinoids. And so maybe there are some people who it benefits and others, it doesn't, I've had,

Tina 1:01:22

I've had CBD be very beneficial for pain relief in patients taking it internally. So pain specifically, right. Or some people for just relaxing for sleep. And I think even when it's helping them with sleep, it's because it's helping with some of their aches and pains. so I've had quite a few people take, CBDs. Some of 'em take THC and CBD together for various reasons. I mean anti-anxiety or you know, that stuff. So we've, I know other plant medicines better than I know marijuana. Yeah.

Leah 1:01:48

And I'm even more cautious when there's THC involved because that I believe has more potential to interact with medications,

Tina 1:01:56

Oh, I, we didn't know. We didn't mention that. We really like to recommend is the good old yoga toes.

Leah 1:02:01

Oh my gosh. I love yoga toes. Yeah. So yoga toes. And then I've also seen those happy feet socks. Mm-hmm cause when you Google yoga toes. For whatever reason, then you start getting all these ads on social media for happy feet. Mm-hmm And so there are these like silicone looking kind of brass knuckles for your feet that separate your toes. And they increase circulation, I think therefore like people with like planter fasciitis, but it just, it feels really, really good. Yeah. Um, I love those yoga toes. Yeah. We'll put a link for those

Tina 1:02:31

too. Yeah. Yeah. So basically just, yeah, just pulls 'em apart a little bit, your puts a little space between the toes and increases circulation as far as I know,

Leah 1:02:39

and that I think it helps with balance too. I mean, I know personally it helps me with balance. you know, when I have like a loss of sensation in certain parts of my feet, but yeah, it gives you that stability cuz like in yoga, you know, spreading your toes as you're standing on the mat is like really beneficial mm-hmm and so the yoga toes do that and you're just kind of like chilling. I always tell people, grab your. Your tea, grab your book, the remote control, grab a blanket, sit down, prop up your feet, put on the yoga toes. I think you start off using them for like no more than 10 minutes. Mm-hmm mm-hmm have your phone next to you cuz you don't need to get a phone call and run across the room. Cuz it will hurt really badly. I, yeah, it didn't have my, my water next to me and I was like, I could totally get up and, and get, get my water wearing these things.

The unofficial theme song

Leah 1:03:25

No, don't do that.

Tina 1:03:26

Mm it's painful. So you could have the socks for that though. The socks would be okay, but not the yoga

Leah 1:03:31

toes. I don't know if you're, if you're, if you're spreading your

Tina 1:03:34

feet apart. I, I isn't the socks just have extra material between the toes though. Like a glove.

Leah 1:03:39

Yeah. I need to, I need to order a pair. I'm gonna order a pair of those socks. Yeah. I recommended them the other day, but I'm gonna try them myself. Mm-hmm cause I shouldn't recommend things unless I try them. So yeah. I'm gonna get myself a

Tina 1:03:51

pair of those. All right. Well happy feed report back on that. I will,

Leah 1:03:55

I will put a post about them. I will post it on the Instagram. So speaking of Instagram, oh wait. Before we talk about where people can find us mm-hmm which is such a weird thing to say, because people are listening to us. So they apparently found us here. Mm-hmm but we do have a song.

Tina 1:04:13

Oh yeah.

Leah 1:04:14

All right. What's a song. The song is shock me by kiss. Nice. You can tell that I'm like a classic rock kind of a person. Yeah. So yeah, I love kiss and shock me is, is our song, which you can find on Spotify on our, an official theme song playlist. Um, and then there's also a link in our show notes and a video on our website.

Tina 1:04:39

Yeah. So that's awesome. Thank you for finding that. Once again, that the Spotify playlist came up randomly in my RV one day, I think I told you I don't nowhere. All of a sudden I turn on the engine and the thing starts playing your. I call it. You are, cuz I have nothing to do with our choices, but our Spotify playlist but what's funny is I didn't the cancer pods. Yeah. I didn't notice it, but my partner was like, I think that's your playlist I was like, is it, it was a long ride to us. So I got, I got to listen to the whole thing. So we had, we rocked out a little bit.

Leah 1:05:11

Oh yeah. And it, you know it, I think it's a pretty diverse, oh, it's awesome. It's a great collect playlist collection. Yeah. So yeah, Spotify is one of the places you can listen to us. Maybe that's where you're listening to us. Now you can find us wherever podcasts are streamed and where that is, is a great place for you to leave a

Tina 1:05:33

review. Yes. It's always helpful to give a little review little shout out, give us five, give us five stars please. Um, and if you wanna give us less than five stars and just email us and have a little chat with us, cuz we're gonna probably share some of the feedback that we have gotten thus far in some later episodes. Oh yeah. We're starting to get letters. Fan mail fan mail oh, and the other place you can, uh, help support the show is buy a coffee and buy a coffee is just a place where you can buy us a cup of coffee, donate $5 to our cause here, keep us on air and keep us going.

Leah 1:06:10

Yeah. Help us pay for all of those little things like web hosting and whatnot. That kind of all the behind the scenes

Tina 1:06:19

stuff, our huge production staff. That's behind us on this.

Leah 1:06:24

Yes. All of all of the hamsters spinning the wheels. Oh,

Tina 1:06:31

that's a, they're very well paid hamsters. Yeah. And they need to eat a lot cuz they're constant. Constantly spinning. Yeah. They're working hard. All

Leah 1:06:38

right. On that note. I'm Dr. Lea Sherman

Tina 1:06:41

and I'm Dr. Tina Caer, and this is the cancer pod until next time,

Leah 1:07:29

this was long