A couple of months back I posted a query re experiencing shortness of breath after six months on goserelin + zytiga, wondering how this might impact me when I joined my youngest Son (32) for a couple of weeks hiking in Yellowstone and Grand Teton.
There were many, many replies and lots of advice, even including the possibility of taking along small bottles of oxygen, that I did in fact see for sale in lots of places in both parks!!
Having made it back alive and in view of the interest in that original post, I thought I would set out some stuff I learned along the way:
- I have some other lung issues (historic scarring or possible progressive deterioration - can't tell from the x-rays, so I'm monitoring it closely), but the short answer is that careful testing showed that prior to the trip I dropped around 25% oxygen handling capacity in the first six months on Zytiga, and that all of this drop was due to a reduction in my blood's oxygen carrying capacity - if anything, my lungs' physical capacity increased slightly during this same period.
- During two weeks in the US at elevations around 2400m (cf. where I live in Melbourne which is just about at sea level), I noticed my at-rest pulse went up by about 10bps to the mid 70s, but that when I hiked or walked up almost any incline at all, my pulse raced quickly up through the 90s to around 120 and above. That said, I didn't feel dizzy or too bad.... and I wasn't even slightly tempted to increase my carbon footprint by buying an aluminium cylinder of oxygen! I'll keep that for a later stage, at which time I'm sure my climate concerns will be quickly junked!
- During the second week I did start to feel tired in the afternoons and began to feel like I was down the end of a long pipe when I was driving... given I found that Americans drive on the wrong side of the road and at ridiculously high speeds, on pretty shitty roads, this became a rather interesting part of the trip (my Son, like many inner city-dwelling millennials, hasn't yet been possessed of the need to get a driving license, so there was no back up here!!).
- These slightly weird sensations reduced when we got back into Salt Lake City (1280m ASL) and were completely gone by the time we landed in LA. And the good news when I landed in Melbourne, is that I was 3KG lighter and my resting pulse was back in the sixties.... all that extra oxygen feels great!!
I have travelled all over the US many times for business, but this is the first time I have been to these two parks, and I guess I finally have to admit that you guys really do have it over Australia in terms of scenery - just so much water everywhere, and the animals are truly spectacular.... shame about all the tourists though!
Anyway... my take is that Zytiga definitely knocks your oxygen-handling capacity around, but that providing your underlying cardiovascular system is in reasonable nick, you'll survive it... it's easy to let it hold you back, but I saw no evidence that it predisposed me to sudden deterioration. Instead, it seemed to me that after a week or so, the body still increased its oxygen capacity in response to reduced atmospheric oxygen levels, as would normally be expected.
I trust this provides some reassurance to others who notice their breathing being affected.
Stuart
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It’s hard to know if it’s the Zytiga or the elevation change. Whenever I return from an extended time at sea level to our home at 2700 m ASL I struggle for about 2 weeks to swim normally and hike without getting short of breath.
Looking forward to landing in Melbourne on 5-September! It is hard for me to get the heart rate up when I swim laps there.
(BTW the Blue Mountains Natl Park outside of Sydney is very beautiful, too.)
Yes mate, it's pretty enough - but no bears, no bison, no moose or elk... I'm going back to Yellowstone and Grand Teton again in a month with my smaller children, just to show them the wildlife..
For clarity, the 25% drop was all in Melbourne, in the first six months on Zytiga...
Blue Mountains sounds great to me. No bears to eat you, no bison to toss you through the air, and no moose or elk to gore you. You don't mention mountain lions. If you are in a tent and you hear one of these scream in the the night, I guarantee you will not sleep and will pray for the dawn.
Yeah, fair enough - although I didn’t mention the drop bears that occasionally beset US tourists in the Australian wilderness... or the crocodiles, that seem to have a way of spotting the ones who can’t read the No Swimming signs....
The drop in hemoglobin concentration caused by ADT and zytiga may be a killer of the oxygen carrying capacity of the blood, particularly when combined with a loweer PaO2.
One compensates by pumping more blood. As you said a good cardiovascular system is essential.
Best of luck on this journey.
Anemia is probably part of the problem. What is your Hemoglobin level?
You're right - through 2018, my haemoglobin was in the range 168 - 176 g/L. After starting Zytiga in mid-Jan, it was down to 152 within a month and to 146 by June, so a total drop of around 17%.
Interesting. I started Zytiga after chemotherapy, so my hemoglobin has actually been increasing from 12-ish g/dL to 13-ish g/dL as recovery from chemo has more than offset the negative effects of Zytiga. In blood tests years before diagnosis, I don't recall ever seeing it be 15 or higher.
My running seems to be completely unaffected, however you could say I'm running 50% more to get the same results I got a few years ago. For whatever it's worth, I've always had a high heart rate when running. Near the end of a 5K my pulse will be in the 185-195 range. It's like I'm a cross between a teenager and a hummingbird
Your “teenager” comment is spot on - I have Life Fitness equipment and they all have the same HR graph on the front, showing a nice linear decline in HR max with age, but mine hasn’t altered in twenty years. However, it usually hovers about 30 bps below where you hummingbirds fly!
Just before I was diagnosed, we visited our daughter in Colorado Springs (elevation >6,000', 1,800 m). This is mile higher than where we lived at the time. I certainly experienced the reduction in oxygen for a few days. I had no desire to drive up Pike's Peak (elevation >14,000', 4,200m). My daughter said that all of her friends who visited from New Jersey experienced it. Her advice was to drink plenty of water, which I thought odd at the time.
You seemed to have done as well or better than me, in spite of your reduced hemoglobin. I'm glad that you enjoyed your trip.
Well I'm glad you survived the U.S. Just to bring you up to date, Beginning in September 2019 we here in the U.S. will begin driving on the left side of the road... We will first begin with Trucks (Lorries) for first 3 months then followed by Automobiles thereafter.
On your next visit I would suggest blowing up many many balloons with OZ air and using them here in the U.S. to eliminate any air assimilation problems.
And your helpful bit of news about the forthcoming shift in US driving rules explains some of the behaviour I observed.... I had thought it was impatient truckies overtaking because they were sick of me sticking to the speed limit, but from what you say, I now reckon they were just early enthusiasts, keen to try out the new rules!!!
The balloon idea is an ingenious one - but I think your border control people might have something to say about it.... you’d think that with so many people apparently coming into the US illegally every day that they’d go easy on old mates who actually ring ahead and let ‘em know we’re coming, but it’s still the full rubber glove treatment... so I think i’ll “pass” on any balloons I bring, so to speak.
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