Mom had bad reaction to chemo. Help please!

Hi everyone,

My 75yr old mom was recently diagnosed with TNBC (stage 3, two small tumors, one node involved). Both the surgeon and the oncologist were encouraging and used the word "curable" and planned to attack this via neo-adjuvant chemo and then surgery (double mastectomy). My mother was in good health and very active for her age but the oncologist was worried about her being 75 and originally thought they would do CMF chemo in lieu of ACT. After a bunch of tests including biopsies and a breast MRI in which it looked like a little more diffuse area involved in the breast in addition to the actual tumors, she changed her mind and decided to give ACT a shot and be a little more aggressive. My mom has always run a bit low on sodium and on her first chemo day when they drew labs, it came back at 129 (normal is 135-144). This didn't appear to be a red flag and they went forward with chemo. The first night was so so with a little nausea and not feeling very well but by mid-day on the second day she was extremely shaky and twitchy and had even more nausea and a headache.

To make a long story somewhat shorter, we had to call 911 because she ended up having a seizure and fading in and out. The paramedics and the ER thought she had had a stroke because by the time she got to the hospital she had facial drooping and word salad going on and couldn't follow commands, etc. They started her on TPA protocol for a stroke (9 min total) before a great neurologist got there and determined the whole episode was due to her sodium dropping (down to 109 which is very, very low!) and not a stroke at all. She was in the ICU for three days and the hospital for a week altogether and pretty much missed out on any of the other chemo side effects due to being so out of it for a few days (aside from almost dying, anyway!). It was pretty traumatic and we're lucky it didn't go the other way so I am very thankful but terrified of the implications of all of this for her treatment.

A nephrologist we saw during the hospital stay talked to us about the sodium episode most likely caused by the cytoxan in the ACT chemo after he studied a few cases (technically called hyponatremia). I guess this is seen quite a bit with lung cancer but only a few cases documented with breast cancer. We saw the oncologist after this at an appointment and we talked about hospitalizing my mom and monitoring her very closely on the next round of chemo which was supposed to happen this past Monday. However, last week we got a call and the oncologist had talked to some colleagues and presented my mom's case in a conference and she was even more concerned about how to proceed.

From what I gathered from the phone call I had with her, none of the documented cases of this type of event had been re-challenged with the same drug after an episode like this — especially no one my mom's age. So understandably, the oncologist was worried and had decided she wanted to talk to the surgeon and possibly go forward with surgery first. I didn't have all of my wits going for me when I talked to her in order to ask decent questions so it was a bit confusing and we're very unsure of what the plan will be after surgery. I know she talked about getting her sodium levels up so it wouldn't drop as far which I assume means more chemo, but if that's the case, I don't entirely understand the difference in attempting it now vs. later (it will be terrifying either way). And I can't imagine this means they won't try it at all as my mom's cancer is aggressive and one dose is not going to cut it, even though the one dose actually shrunk my mom's tumors to the point she's having trouble finding the one that was the most prominent (the only good news so far it seemed to work).

Other than being terrified myself of what this all means and how we're going to get her through it, I suppose my question is if anyone has ever had anything like this happen or they had to stop for some other reason and how you think the oncologist might proceed in a case like this with the worry about sodium vs. another event occurring. This has all been so overwhelming, I feel like I can't even think straight and I'm having a hard time trying to be positive when we feel like we're back in the pre-plan limbo again. I am an only child and very close to my mom and I will be there for her no matter what, but I just want to be able to give her support and help her understand everything and right now I don't understand any of it myself so just in a tough spot and looking for some support and advice or suggestions from any of you lovely ladies on this board.

Thank you so much for indulging this very long, late night post from a very scared daughter.