Covid-19 Vaccine Prep and Administration, Part I
Disclaimer -- I'm not a doctor and am not writing from the perspective of a medical professional. If you have questions or concerns about the vaccine or any of the topics I write about below, please check with your medical team!
As most of you, I've been staying at home a lot since January of 2020 because of COVID-19 and that has changed our lives fundamentally in our household. My household consists of me, my husband, my two boys (5 and 7 years old), and my parents, who are both over 65. While my Dad and husband have been able to adjust their jobs to ensure that they aren't in physical contact with others, my mom is retired, and my boys are in school physically. We made the decision to send them to school because of their academic needs (no one can do kindergarten online!!) and the fact that our school has done an amazing job of keeping them safe (shout out to Palmetto Elementary and our principal, Eric Torres!).
Covid-19 vaccine approval
When the news came about the Pfizer vaccine's approval by the FDA, I watched very closely how the medical community responded, particularly the doctors who post regularly on Twitter. If anyone wants to follow the hashtag #MetTwitter, you will find a wealth of information shared by various doctors and particularly medical oncologists. I've learned so much by interacting with them in real-time about Covid, the vaccine, studies, clinical trials, and quality of life issues. I've honestly not encountered any of them unwilling to give of their time and expertise to patients for the benefit of anyone and everyone able to follow and read.
Initially, my medical oncologist was leery about recommending that I take the vaccine, probably for the reasons all of the doctors were initially wary. She told me that because no one with active or metastatic cancer was included in the trials, that we just didn't know how it would work, not just because of the cancer but also the many medications we're all taking. She didn't just say, don't take it, she said wait to take it until she'd looked into the details. Now I didn't just leave it in her hands, I've read everything I can and I've interacted with other patients and doctors on social media and otherwise.
Vaccine considerations when living with MBC
When I talked to my doctor last week, she gave me the green light to schedule my first appointment and that occurred on Tuesday, January 12, 2021. Here's the list of considerations that she and I discussed as we prepared for my appointment and afterward that might be helpful.
First of all, we looked at the medication I'm taking. I am on Piqray and Kisquali as my main targeted therapies. Piqray doesn't affect my immune system in any discernible way, but Kisquali does. My doctor follows my white blood cell count (WBC) and my absolute neutrophil count (ANC) to gauge how my immune system is doing. The way a chemo nurse explained it to me is that the WBC are the adult cells, ready to protect me from invaders and the ANC are the baby and juvenile cells waiting to mature when needed. Different from IV chemo, which wipes all of the cells out, Kisquali (and other CDK4/6 inhibitors) often leave the immature cells alone. This means that I do have some additional protection even though my WBC count is low. What we decided to do is have me stop taking the Kisquali about a week before the appointment for the vaccine, which basically means I get an extra week off, although I prefer to call this a medication holiday, it just sounds a little better.
Secondly, we discussed where I would get the shot and I posted on Twitter to get input from other doctors and patients. Now, I had a lumpectomy in 2017 and only had four (4) sentinel lymph nodes removed on the left side. Since those nodes were negative for cancer cells, I didn't have any other nodes taken out. Despite the fact that many people have told me that I didn't have sufficient lymph nodes taken out to avoid using the left arm for blood draws or blood pressure cuffs, I do tend to just use the right arm just in case. My doctor (and everyone on Twitter) confirmed that I should avoid using my left arm for the application of the vaccine, just in case.
Third, the Pfizer Covid-19 vaccine needs to be intra-muscular, so inside the muscle itself.1 One caution I've heard is that the person giving you the shot should NOT pinch the skin when inserting the needle to ensure that the vaccine doesn't just get injected under the skin. The vaccine needs to be entirely inside the muscle to be effective.
Possible side effects
Fourth, the main side effect from the first shot I've heard about and read about is that the arm where the vaccine was injected will be sore; I've also heard that about 50% of the recipients have a day or so of flu-like symptoms from the second shot. For me, the injection site was a little sore for a few days and I felt twinges deep in the muscle when moving my arm. That dissipated quickly. The day after the vaccine, both of my palms turned bright red. I took a Claritin and that's also dissipated.
For anyone who has gotten the vaccine, make sure to register on the cdc website to share all of your experiences and the side effects after receiving the vaccine. This data will be invaluable as everyone works to gather information on everyone getting the vaccine. I'll definitely update everyone on my experiences! Stay safe and please do consider getting the vaccine when it is available to you in consultation with your medical team. The closer we get to herd immunity with the vaccine, the closer we are to having the ability to be more active and see other people!
Have you gained new friends in your metastatic cancer journey?