April/May 2012 Chemo hang out

vjm - great to hear from you - I was getting worried!  And guess what - we are now BOTH PFC!!!!!!!!!!!!!!!!!!!!!!!  Yes!   

mcm24 - I am also icing during Tax (4 tx finished).  So far, nails intact.  I'm afraid of jinxing myself, so I won't claim full victory until I'm a few months PFC.  Only ~ 1 week PFC right now.   Start 15 min before, continue during, 15 min after.  I do periodically take my toes/fingers out to go to the bathroom, text someone, or take a drink of my ice that I also chew the whole time (to prevent mouth sores - it works - none so far!).  I get my nails REALLY cold, but I am sure to bring them out if it becomes painful to avoid frostbite.  You can't ice that much for 1.5 hours without hurting yourself - so be reasonable and take breaks as needed - just not too long.  I've met other women who have iced yet still lose nails - so I'm pretty hard core about getting them cold enough.  I use 2 baggies of ice and sandwich my nails between them.  I bought four $1 store little coolers to keep them from leaking all over the place - just stick my hands/feet in them. 

 I wear fingerless gloves and socks (just cut the tops off of old socks) to keep my hands warmer, and I also bring an electric blanket and warm clothes to the clinic to make it more tolerable for me.  I'm an ice wimp.  YMMV.  

 I also paint my nails with Sally Hansen Hard as Nails several times a week, and I avoid using my nails for anything. 

 I will PM this to you as well. 

Indigo - no problem - I just PM'd this info to mcm24, so I can just copy and paste!

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Taxol is known to cause neuropathy. It actually causes it more than Taxotere does. You can take supplements, if approved by onc, to reduce the incidence of it, hopefully. Well worth it, neuropathy is something you want to avoid if you can. Options are:
10 mg L-glutamine powder stirred into a drink 3 x daily (total 30 g/day)
100 mg Vit B6 daily
1000 mg acetyl-L-carnitine with meals 3 x daily (total 3000 mg/day). This is being tested in a clinical trial right now, so obviously it has some research behind it to get that far

I'm doing 50 mg Vit B6 (100 mg was too much for me - actually CAUSED tingling) and the acetyl-L-carnitine). I've had intermittent tingling (after my 3rd chemo) in my face, feet, and hands - but nothing has lasted. I will stay on the ALC for another month or two b/c sx can present in a delayed fashion after chemo.

Good afternoon to all you beautiful ladies and welcome to newcomers.

I am home now after getting treatment #2 and the port works great!  I am so glad the decision was made to have the port installed. 

My MO is surprised that the anti-nausea meds didn't help me with treatment #1 and I'm feeling very nauseaus now after #2 - I was finished at 11:30 and am feeling the side effects about the same time I did with #1. 

Sometimes I don't understand when we know that treatments affect everyone differently, why any doctor is surprised if your side effects are not the "norm".  She also does not understand the bone pain but as you all know from some of us here, severe pain does happen.  I do like my MO though and feel comfortable with her.    I have lost 4 pounds since last treatment but am not surprised since eating anything of substance just doesn't work right now. 

I'm going to go rest now because I have to feel better for tomorrow's CT scan.

I hope everyone is feeling good today.

Hugs to all,

Misty

mistym - feel better soon!

Dancetrancer, thanks again - I am copying and pasting all this stuff onto my Taxotere Prep document! 

I have an aversion now to Lemonheads.... At least I didnt' love them before chemo!  

Dance- I love the thing you posted!

Hey all - this just came into my inbox (I signed up for oncology newsletters, yes, I'm a geek).  I wanted to share it in case it helps someone who is not responding to antinausea meds - looks like there is a new option you could ask your onc about.

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Olanzapine Overcomes Chemotherapy-Induced Vomiting and Nausea
Elsevier Global Medical News. 2012 May 23, K Wachter

The antipsychotic olanzapine trounced standard therapy for breakthrough chemotherapy-induced nausea and vomiting in a clinical trial that could change the way some cancer patients are treated.

In the double-blind phase III study, 30 (71%) of 42 patients, who received olanzapine (Zyprexa) had no emesis, compared with 12 (32%) of 38 patients who received metoclopramide (P less than.01) during a 72-hour observation period after highly emetic chemotherapy.

In addition, 28 (67%) patients on olanzapine had no nausea, compared with nine (24%) of those patients on metoclopramide (P less than .01), said Dr. Rudolph M. Navari, who presented the study during a press briefing in advance of the annual meeting of American Society of Clinical Oncology, June 1-5, in Chicago. Dr. Navari is the director of the Harper Cancer Institute at Indiana University in South Bend.

ASCO president-elect Dr. Sandra M. Swain, medical director of the Cancer Institute at Washington Hospital Center, called the findings "a great step forward for quality of life for our patients.

"This is a huge advance," said Dr. Swain, a breast cancer expert, who co-moderated the teleconference. "We've come a long way to really treat and cure these patients ... these side effects can be intolerable to patients. Sometimes patients will opt out of curative treatment, and we certainly don't want that, when we know we've made advances."

The researchers included chemotherapy-naive patients who received highly emetogenic chemotherapy: more than 70 mg/m2 cisplatin, or more than 50 mg/m2 doxorubicin and more than 600 mg/m2 cyclophosphamide.

Patients who developed breakthrough emesis or nausea despite guideline-directed prophylaxis were randomized to receive olanzapine or metoclopramide. Pre-chemotherapy prophylaxis included intravenous dexamethasone (12 mg), intravenous palonosetron (0.25 mg) and intravenous fosaprepitant (150 mg); post-chemotherapy prophylaxis was daily oral dexamethasone (8 mg, days 2-4).

Patients received 10 mg oral olanzapine for three days or 10 mg oral metoclopramide three times daily for three days. Patients were monitored for emesis and nausea for the 72 hours after the initiation of therapy. In addition, nausea was measured by patients on a visual analog scale (0-10), with 0 being no nausea and 10 being maximal nausea.

Patients in the two groups were similar for age, sex, Eastern Cooperative Oncology Group (ECOG) performance status and diagnosis (Five bladder cancers, 40 breast cancers, eight lymphomas and 27 lung cancers).

"Both olanzapine and metoclopramide were well tolerated with no grade 3 or 4 toxicities," said Dr. Navari. No central nervous system toxicities were observed in either group.

Olanzapine is indicated for treatment of psychosis and is associated with weight gain, but the side effect should not be a problem for cancer patients.

"The side effect of weight gain occurs in patients, who receive the drug for three to six to nine months," Dr. Ravari noted. "So using it for a short period of three to four days once a month - we did not see that in the current study, nor did we see that in previous studies."

Dr. Navari had previously reported that patients receiving highly emetogenic chemotherapy were about twice as likely not to experience any delayed nausea with an olanzapine regimen compared with a standard aprepitant (Emend) regimen (68% vs. 37%) in a phase III clinical trial. The two regimens worked similarly well for preventing acute nausea and for preventing both acute and delayed vomiting, that study found.

IndigoMont- Here is my latest version of Icing 101 so you don't have to go hunting...  HUGS!!!

• Time period for icing- You will for 1/1/2 hours in total= 15 minutes before the Taxotere infusion + 1 hour during the infusion + 15 minutes after the infusion.
• Ice- You can use frozen peas in quart size ziploc bags marked "Do no eat!!!" and reuse those bags of peas.  I opted to use ice.  I have an ice tray that makes small rounded bottom circular ice.  I tried the peas and decided I liked the ice better because I thought it stayed colder longer.  My infusion center has ice available for me to use if I want to use it.
• Transporting ice to infusion center- I use a cooler with a freezer pack plus take extra infusion ice bags.  
• What to put the ice bags in- That is a personal preference.  Some just put the ice bags on their feet and wrap a blanket around them so the bags don't fall off.  Some use insulated lunch bags and put the ice bags in those.  My hands and feet are small so I'm using some neoprene wine cooler bags that I bought at Target for $6.99 each.  I figured I could use the wine bags later on.  I'm still able to hold an insulated mug so I can drink really cold water and eat ice during the infusion.  
• Hand & Feet Protection- I wear thin sports socks on my feet when I ice the toes.  The socks keep the rest of my feet warm during the icing.  On my hands, I wear a pair of knitted wristlets/fingerless gloves to keep the rest of my hands warm.  Some people take their feet/hands out of the ice periodically; however, I don't do that.
• Process- I let the infusion nurse know that i'm icing so we can coordinate when I should start the icing. Once I know when I'm going to start the infusion, I put the ice bags in the bottom of the Neoprene bags.  I put the ones on my feet first and adjust the ice bags so my toes nails are covered.  I then put the ones on my hands on and adjust the ice to cover my fingernails.  My husband helps me with this process.

Hello all hope thing are going well for all, I'm feeling pretty good this week no pain, monday was the first day with no pain since 2 days after my second treatment.   My treatment is next Wednesday better enjoy this weekend. Blessings to all

My plan is to do my tissue expander exchange 1 month after I finish chemo (I finish on July 23rd) and then start rads after that. Looks like I have 25 sessions in store.



My doc said as long as you are young and healthy and healed ok the first time it's fine to do it before rads. Otherwise she recommends waiting 6 months from the end of rads. She did say there is a risk the radiated side will end up smaller than when you start.



Rose

Dance and Melrose;  Thanks for the info.  

Trichic:  Good analogy.  It brought tears to my eyes.

MistyM:  hope you're feeling better soon! 

Chapter4 - basically, there are three ways to reconstruct (that I'm aware of) - implants, flaps, and fat grafting.  Fat grafting is really new and only a few select surgeons are doing it around the country.  (If it is something you are interested in, I've heard good stuff about Dr. Ahn in NYC.)  Each type of recon has it's pro's and con's, for sure. 

With radiation, it does complicate reconstruction, b/c the tissue is more fragile. You have to wait at least 6 months after rads to start recon, some PS's say 1 year.   It can definitely be done - you just need to know there can be complications.   Here are some links to more info.  FYI, the 2nd link has boobie pics showing capsular contracture and how they corrected it nicely.

Reconstruction after radiation? 

Radiation and Reconstruction