Neulasta Question & Port Question

Hi, DebRox. I get the sense from my onc and the many posts I've read on this site that the Neulasta decision is different among onc's. I didn't get the Neulasta until day 8 after my first chemo when my blood count dropped from a healthy 7.1 to 2.9. Now I'm automatically on it, every 3 wks, the day after TCH chemo. I 've read of others who get it automatically from the start, and yet others who only get it when counts are down.



The port decision also seems to have to do with whether you have veins worth poking. I' m up for 18 weeks of poking and have tiny veins, so the port was a must. I know a woman who's done her 4 months in good veins.

After my original diagnosis, I did dose-dense chemo and neulasta was required.  I've been on chemo for the last 2 1/2 years straight (after Stage 4) diagnosis and they have not done neulasta.  I had chemo today and talked to the Onc about it and she said if the white cells were passable, she would not do it.  So I guess it's controlled by the chemo they give and the preference of the Onc.  I should also mention that I'm on my third Onc.

I'm on my third port, just had this one replaced a couple of weeks ago.  If I were in your shoes, I don't think I would get a port.  Usually Onc's push for this - it's interesting yours is not.  I had so much trouble with the second port and had an appointment to have it removed and not replaced.  The Onc talked me into giving it another shot.

I would listen to your Onc on this one.  Good Luck to you. 

I had easy veins, so did not get a port for my TC. I'm glad of that because it would have been one more surgery and one more thing to worry about. I did have the chemo leak? once under my skin, which caused a small stain-like pattern on the underside of my forearm. I don't know how better to describe it. It's gone now. 

They gave me neulasta automatically after each one, but if I had to do it again, I would have asked to be monitored instead to see if I needed it. The neulasta gave me headaches. I know it was the shot because on one single occasion, I convinced them not to do it for a few days and just to check me. Then because I was going away, they convinced me to do the neulasta one more time and the headache came back. 

DebRox- I too had 4 tx of TC. I got a port only because I have tiny veins. I did not receive a Neulasta shot after my first tx (my insurance wouldn't cover it) and my white counts plummeted and I ended up on IV antibiotics for a week. My insurance agreed to pay for it for the last 3 txs. I took a claritin or Advil the day of my neulasta and the day after and I had very minimal bone pain- just a little achy.

I agree with Ruthbru on both counts.  If Neulasta is available to you, it is very effective in preventing infections which could delay your chemo schedule.  With regard to the port, when I even suggested to my BS that I get my first A/C without a port, he was emphatic that I get it placed prior to receiving chemo. Just my experience - whatever you decide, good luck and best wishes! 

I have 2 different views on this as my dad is going through treatment for small-cell lung cancer as I am going through this.  He had his first couple of chemo's with no port and has never had Neulasta and only had one treatment delayed because of low blood counts.  I refused the Neulasta shot and it turned out to be a good thing because my insurance company doesn't pay for it and I would have been on the line for the thousands of dollars!!!!  If my counts go low, I'll do the 3 or 4 shots of Neogen or whatever it's called instead, as you don't have to wait for chemo after that one but I'd rather avoid any if I can.  My own personal choice!  But for me, a port was a must as was the Emla cream, another thing Dad didn't get!  I think doctors just think men have to be tough or something, LOL.

I think the main difference between Neulasta and Neupogen (I think!!!!) is that with Neulasta you only get one shot but it must be given 14 days prior to chemo and with Neupogen you have to get 3 or more shots but they can be given much closer to chemo, so you might not have to delay but you get more pokes!  Neupogen is the older technology, I believe.  Neulasta ranges from $3 to $12 thousand per shot so my insurance company won't cover it unless you already have an infection which means I'd be delayed anyway which I didn't know before I decided not to chance the pain and another time off of work for a trip to the doctor.  My counts were way way low last week, I go today for Herceptin again so I'll see if they are any better, today will be day 14 and if not, see what the onc wants to do before #2 next week. 

Are we having fun yet????

CarylC - If your counts drop too low your onc will probably put you on a prophy antibiotic as opposed to giving you Neulasta.  Neulasta won't fix an infection, just boost your WBC production.  What was your WBC on your last CBC?

The order for Neulasta is this:  1) chemo 2) Neulasta 24 hours later 3) CBC 7 days later to determine if Neulasta is working, which is occuring simultaneously with your white count nadir (lowest point) 4) if you are chemo every 3 weeks you would have 13 days until your next tx to solve your low white count problem.

Thanks for the info.  I am kind of worried and the nurse even made a comment today when I made my appt for chemo next week (today was Herceptin only) that she didn't think I'd get chemo with my blood test results.  They went down again.  My WBC was 2.4 and my GRAN was 0.3 (it should be between 2.0 - 7.8).  Everyone of my test results went down for the 2nd week in a row but last week the nurse told me the GRAN one was the one that would stop me.  I talked to the doctor too, told him I had a sore throat, swollen glands that were sore to the touch but temp was only 99 and he thought it was from the taxotere and said let it go a couple of days.  

Guess I'll find out what happens next Wednesday.   

I ended up having an allegeric reaction to Neulasta and would break out with a rash, nothing else. Never had issues with pains, I think because I with taking L-Glutamine powder and B6/B12.  It took awhile to figure definitely that the rash was caused by the Neulasta shot, but I had to keep taking it since I was on DD.  Tried skipping it once and my blood counts tanked.  Benedryll worked great, but made me drowsie, so finally switched to Claritin and it helped, but didn't stop the rash.  

I did have issues with my GI tract, but I think it was because of the chemo.

Need2_BFree - This is old Tread that has not been posted on for 6 yrs until you did today. You might get more replies that are pertinent to you if you would start a new Thread with your concerns/questions/thoughts.

I was given Neulasta the day after each of my 4 DD A/C neoadjuvant infusions. My blood count was Great throughout. When I started 12 weekly Taxol adjuvant 5 weeks after last A/C, I was told no need for Neulasta (unless something 'strange' popped up). Didn't - I had no infections (even 'sniffles) at all from the start of A/C through Taxol and then Rads. I didn't try to stay away from people and activities at all either.

The only 'thing' that ever showed up 'bad' during my 16 total infusions was 1/2 way through Taxol, my K (potassium, not Vit.K) dropped dangenerously, so had to go on mega doses of K. Still 7+ yrs later have to take K daily to keep it 'normal'. We are each unique!

The only 'reaction' I had to Neulasta was, almost to the minute, 2 hours after injection I would go to sleep for 2 hours (again almost to the minute) I would wake up as alert as ever. Never any bone/joint pain at all.

I am one who is very pro ports. I have great veins and intended to do all I could to protect the ones in my non-surgery arm as after surgery it is advised to not use veins on surgery arm for blood draws, have BPs done or vaccinations to hopefully lessen the possibility of LE (LymphEdema) developing. So if veins are damaged in other arm that leaves leg/foot for draws/IVs and leg for BP. Not worth the chance to me - want to keep veins good in the one useable arm. (Just my thoughts - others have different ones.)

When I was going through chemo, I never used EMLA cream. The Facility had a 'Numbing Spray' they used and barely felt a prick. My flushes were not/are not done at the Cancer Center since end of TX, the place I go for flushes e very 2 months does not have the spray so I use the lidocaine/prilocaine cream (put it on about an hour before and cover it with 'Saran' wrap before flush). Never feel 'anything'. There was one time (long story I won't go into), when the port was accessed with nothing to numb the area and it HURT BAD.