As you will quickly learn, the title of this post is a bit of click baitery. I encourage everyone to get the Covid vaccine if they haven’t already, but if you’re either a cancer patient, or getting a screening test for cancer, there’s three things you should know about the vaccine that may affect the ideal time to get your shots. I of course have learned some of this due to receiving a poorly timed Covid vaccine.
The first thing to be aware of is that your immune response to the vaccine can cause your lymph nodes to swell. If you have a CT scan or similar imaging test at this time, the enlarged lymph nodes can be interpreted as cancer progression. A number of women have had biopsies due to spots seen on mammograms after getting the vaccine, only to find out that it was a false alarm. In my personal case, I had a CT scan two weeks after my first shot that showed significant improvements in my liver and bladder, and potential progression in my lungs, particularly in the left lung conveniently located close to the injection site.
My oncologist was very happy with my scan, and it was only after I read the radiologist report online that I found out that there were suspicious things going on in my lungs. I asked my oncologist to explain why he was so happy despite this, and to his credit he sat down with me and we went over the scan again during one of my chemo infusions. He explained that the suspect lymph node had been enlarged but stable for some time, and was right next to several blood vessels. It’s hard to distinguish blood vessels from swollen lymph nodes when looking at a single slice of a CT scan, and he thinks the node may have swollen slightly and visually merged with one of the blood vessels making it look even larger than it really was.
During my cancer journey I’ve routinely had some small lesions in my lung that usually disappear quickly with an effective chemo. What I’ve never had before that I had this time was “ground glass” artifacts. I can’t explain what these are, but first heard of them in the context of Covid. The lung damage caused by Covid shows up in a CT scan as large areas of ground class artifacts. I had a few scattered areas. While they could also be cancer, it’s just not consistent with how my cancer has historically behaved. I’ll come back to these artifacts shortly.
I of course wanted to do anything possible to get answers now. I had two proposals. First was a biopsy, but due to the relatively small size of the lymph node and it’s proximity to blood vessels it would be difficult to perform a biopsy without potentially poking a hole in an artery. If the next scan shows further enlargement, then it would be safer to biopsy and at that point he would want a tissue sample to try to figure out why chemo is working everywhere else but there.
My second proposal was just to shoot the lymph node with radiation without doing any further tests. I called this proposal “shoot first and ask questions later”. Unfortunately the lymph node is poorly located for radiation and the radiation field would damage a lot of healthy lung tissue around the lymph node, which would be bad for somebody who likes to be active and engage in endurance sports. He would prefer to switch to a different systemic treatment based on the results of a biopsy if it comes to that. So both proposals were voted down, and like in real estate, location, location, location is really important with potential tumors.
So the plan is to do another scan in mid June, about 7 weeks after my last Covid shot which is beyond the 4-6 week window recommended. I could worry about what’s going on in my lungs for the next month, or I could take advantage of knowing that my treatment plan won’t change and take a trip to visit my vaccinated mother who I haven’t seen since Christmas 2019. I leave for Connecticut tomorrow, side effects willing.
The second thing to be aware of is that the Covid vaccines, while not being an actual virus, are not inert. In the actual virus, the spike protein activates a receptor on the cell surface which allows the virus to gain entry to the cell and also sends signals that alter the behavior of the cell. Basically, my understanding is that the result is that the cell metabolism speeds up, produces more copies of the virus, and the cell is left more susceptible to damage from the virus.
The Pfizer and Moderna vaccines cause your body to produce a large number of spike proteins, which your immune system then produces antibodies to. The antibodies will inactivate the spike proteins, preventing the virus from binding with the cell receptor and gaining entry. However, before the antibodies are made, that spike protein is still activating the cell receptor and altering the cell’s metabolism. This isn’t directly damaging to the cell, but could make it much more susceptible to damage from something like chemotherapy (in cancer patients) or acid (in laboratory mice). I had a chemo infusion a week after my first shot, which was followed by a CT scan a week later that showed the ground glass damage to my lungs. I’m thinking this is not a coincidence.
For those wanting to know more, the preceding paragraphs are based on this scientific paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827936. If you are scientifically minded, feel free to review the paper and let me know if my conclusions are off base.
In addition to the ground glass artifacts, my “running” performance had deteriorated significantly. In March I was closing in on a 15 minute mile pace (somewhere between a brisk walk and a slow jog), covering 4-5 miles at a time, and set myself a Big Hairy Audacious Goal (BHAG). By mid April I was barely able to cover 2 miles at a 20 minute pace and my lungs felt horrible afterwards. My already modest aerobic capacity fell into a pit.
But as of today I perhaps have hit bottom. I did a 2 mile moderate to brisk walk, and though it required a stratospheric heart rate and heavy breathing, my lungs didn’t feel like crap for a change. Rather, it felt similar to running the final mile of a 5K, only I was going at a causal walking pace. To me it’s a sign that my lungs might be healing, that if I go slow enough I can start going further again, and perhaps some aerobic capacity will return with time.
And the final thing to be aware of was something I’ve long suspected but recently heard on TV. They were talking about how vaccinated people no longer need to wear masks, but one of the potential exceptions is cancer patients, where chemotherapy may suppress the immune system and reduce the effectiveness of the vaccine. This makes perfect common sense but of course there’s no actual data on it. I’m slightly extra cautious because of this but generally feel that my immune system, while suppressed, is still functioning at some level so I’m sure I have some antibodies and thus some level of protection from the virus. I certainly feel safe around other vaccinated people, but wouldn’t dive into a mosh pit of anti-vaxxers.
So that’s what’s been going on with me and some things you should be aware of about the vaccine. To summarize: If you’re getting a cancer screening test (blood test or CT scan), I’d recommend getting the cancer test first, then get the vaccine. If I had waited two weeks to get vaccinated I wouldn’t have invalidated my recent CT scan.
Also, if you’re near the end of chemo, or about to start chemo but can delay it a few weeks, try to get the vaccine while you’re not actively on chemo. This will reduce the potential for additional damage caused by chemo, and your immune system will be able to mount a full response to the vaccine.
And if you’re like me, have been on chemo for months with no planned end in sight, just get the vaccine, prepare for some enhanced chemo side effects (after I noted that the vaccine seemed to make chemo worse, the nurse practitioner said I wasn’t the first patient to say that), and take a little extra caution around unvaccinated people. As rough as the vaccine can be during chemo, it’s far better than catching the actual virus.
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