Tuesday, September 14, 2010

Anatomy of a hot flash

I'm bald, tired, and nearly always thirsty.  The chemotherapy makes me ache.  It makes me tired, too, but also, just to add insult to injury, it also gives you insomnia (though that is exacerbated by the steroids they give you to make you feel better).  I awake nearly every two hours throughout the night.  Luckily, I can usually fall back to sleep, but there are times I do not, and those are fun.  The targeted therapy I just began can cause a skin rash (similar to acne) and will cause diarrhea (they laid that out for me in no uncertain terms).  But overall, the worse symptom has to be the hot flashes.


Chemotherapy messes with your hormones and suppresses ovarian function (i.e., you don't ovulate or menstruate).  Thus, patients are basically thrown into a chemical-induced menopause.  It's lots of fun. You are just sitting there, minding your own business, and suddenly the skin on your head, neck and chest begins to prickle.  A flush climbs up your neck and reaches your cheeks, making you feel hot.  But by far the best part is the sweat itself.  (Personally I sweat on my back, neck and chest and head most often, but there are times when I'm lying in bed that my entire body feels sweaty.  And the sweat on your bald head feels lovely, believe me.)  


There is no pattern to these little flashes of hell, they come morning, noon and night.  They come when I'm relaxed, when I'm running around, and when I'm sleeping.  There's really no preparation.


Sometimes I have warning, heart palpitations or shortness of breath. Other times, nothing (most times, actually).  Breastcancer.org defines hot flashes as follows:  "the sudden, intense, hot feeling on your face and upper body, perhaps preceded or accompanied by a rapid heartbeat and sweating, nausea, dizziness, anxiety, headache, weakness, or a feeling of suffocation."  It's as accurate a definition as I can find.


Why does this happen?  The simple reason is the change in hormones, specifically estrogen. Low levels of estrogen affect the hypothalamus, the "termostat" of our brains, the area responsible for regulating our sleep cycles, appetite, and body temperature. The drop in estrogen levels causes the hypothalamus to misread our body's temperature and the body's response is, well, not fun, but biologically the brain signals our body (via epinephrine, serotonin and related molecules) to stop the heat, even if there wasn't any heat prior to this signal.  So the heart beats faster, your blood vessels dilate (which actually helps cool the blood) and you sweat because it's the body's cooling mechanism.  This is how our bodies normally regulate their temperature, but because of the screwed-up hormones it triggers these responses randomly instead of in response to overheating.  (Which, incidentally, my body does not do right now, or at least it didn't this summer in the humidity and heat.)


The next time you see me sitting quietly across from you and I suddenly break out in a flush and sweat, be kind.  It's terrible.  And I learned this after my second hot flash:  I called my mom immediately and apologized for making fun of her while she went through menopause.  I really do take it all back now.

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