Anyone on just Taxotere and Cytoxan?

beachmom/Lee, I have a theory...and that's all it is.  I have no evidence whatsoever to support my theory.

I also get a mild fever--generally no more than 99.5 to 99.8 degrees--at the same time the "Neulasta" bone pain hits.  Or, at least I'm attributing that pain to Neulasta; I guess it could be due to the Taxotere, which would make this even more interesting.  Maybe someone who is getting TC but not getting Neulasta or Neupogen could take their temp daily and see if the same temp increase occurs at the same time....before they get neutropenic and end up in the hospital, of course.

Anyway, my "Neulasta" aches and pains hit around day 4 or later that night, and continue through day 7.  At the same time, and with hardly any lag phase, I get that low-grade fever.  OK, so what's causing the fever?

The standard line is that the fever is caused by an infection which may be so mild as to be subclinical.  I think that explanation is boring, and I'm not buying it at this point.  The reason is that the fever is coming way too early for it to be caused by a neutropenia-related infection.  Even with Taxotere, where the neutrophil "nadir" hits earlier than with Cytoxan or Adriamycin, our neutrophil counts don't go down (on Neulasta anyway) until around day 6 or 7, and they're back up by day 8 or 9.  Infections have incubation periods, so I would think it would take at least a day or two for an infection to get established during that low-neutrophil period before we actually started getting sick and displaying a fever.

If the fever is not caused by an infection, then what is causing it?  Well, here's my off-the-wall theory, which I will gladly set aside if someone offers another reasonable explanation.  I think the fever is caused by the same process that causes the Neulasta bone pain.  Fever, after all, is really triggered by prostaglandins that our bodies produce when inflammation occurs.  Bacterial infections don't cause fevers--it's our inflammatory reaction to the bacteria that results in a fever.  I wonder if maybe it's our bone marrow reaction to the Neulasta that is resulting in a fever.

We know Neulasta and Neupogen cause bone pain.  The oncos think the bone pain is due to "crowding" in the periosteum of the bone as newly minted neutrophils all try to get out at the same time.  Pain occurs from stimulation of nerve endings, which can be from pressure or it can be from release of inflammatory-type chemicals like prostaglandins and leukotrienes (think "arthritis" if you want a mental picture).  Our oncos (mine at least), plus lots of published research reports, say that ibuprofen can help decrease the bone pain from Neulasta.  Ibuprofen is a major NSAID that works by inhibiting prostaglandin production, thus decreasing pain (think "make that headache go away," or "make those menstrual cramps go away," if you want a mental picture).

Hmmmm...we also have anecdotal evidence from our sisterhood that Claritin helps reduce the bone pain from Neulasta.  Claritin is an antihistamine (H1 blocker), so how could that possibly relate?  Well, here I go off on a limb again.  There is nothing I can find to support the argument that Claritin works because the bone pain from Neulasta is due to an "allergy" to the Neulasta shot. If we were allergic to Neulasta, we'd develop an allergic reaction (hives, sneezing, swelling, difficulty breathing, etc.).  It's a lot more likely that Claritin is working (if it does work) by blocking H1 histamine receptors as it usually does, and as a result, it's blocking pain.  Besides causing sneezing and sniffling and watery eyes, histamine can trigger pain receptors.  Block those receptors, and you block the pain.

The big question is, what is causing the release of all those inflammatory chemicals, like prostaglandins, leukotrienes, and histamine, after a Neulasta shot?  I think--based on no scientific data--that the movement of those neutrophils through the periosteum is causing release of inflammatory chemicals, including those that cause pain and fever.  Maybe some of the neutrophils are dying and releasing their contents.  Maybe they're becoming activated as they get squeezed out, and they dump out their contents.  They are awfully frail little cells, despite their aggressive behavior during battle.

Guess what?  Neutrophils contain zillions of enzymes and...prostaglandins and histamine and leukotrienes!  So maybe the bone pain and fever are coming from the neutrophils themselves, or maybe it's related to the pressures/activity in the periosteum.

In any case, I have no money riding on this bet.  Now that I'm retired, I'm free to speculate like everybody else!

otter 

Kfalls -  my allergic reaction to Taxotere showed up as dizziness, sever abdominal pressure, hot flash that went all the way through to my ears, and I turned bright red.  They put oxygen on me immediately so I never experienced shortness of breadth.  Everything was pretty much settled down after 30 minutes.   My onco suggested switching to Abraxane rather than pumping me up with additional meds to counter the allergic reaction.

SharonS - sounds like you may pull ahead of me with treatments.  For some reason, my rad onc's office does the simulation (and 3 tattoos) separate from the mapping (drawing) and that may also be separate from the first radiation treatment.  Did the simulation today.  "They will call me in a few days to schedule the next session" - argh!  Just want to be getting started since the sooner it starts, the sooner it ends! 

I'm also feeling tired still after Tx#4 on April 30^th .  Granted I pushed things by traveling with my DH last week to his company's annual conference (it was in the Bahamas so how could I not go?  Yes, I used SPF 50 instead of my pre-BC 15).  Taking naps occasionally and still sleeping almost 9 hours every night.

Finally got my butt in gear beyond just walking up and down my street.  A local fitness center offered a midweek afternoon special that was just too good to pass up so I attended the strength circuit training class today and am planning on going to the Aquatone class tomorrow.  I have the extra 12 pounds from chemo to address and then the excess that I have been carrying for way too long.

Hope all are doing well.

Great theory Otter - better than anything I have heard - maybe you should publish it.

Karen

Hey, what a great idea!  Can we have our next tx's in the Bahamas?  Or, better yet, what if we all sneak off to the Bahamas and our oncos can't find us?

No, I'm not a nurse.  (I don't even think I could play one on TV, 'cause I puke at the sight or sound of someone else retching.)  I had to take a lot of medical-type classes for school, and then I worked in a "health professions" field as a teacher/researcher for 25 years.  One of the things I really enjoyed about my job was being able to read articles that came out in medical journals each week.  Now I guess it's a hobby, but it's way too focused on one particular medical subject!

otter

RobinK, you can change your ticket for a $75 fee, right?  Maybe it's not too late.

otter 

Hi, all--

Here's an updated tx calendar for those of us on Taxotere & Cytoxan (with Tigwin included 'cause we've adopted her). Dates with question marks or parentheses are those that I've calculated and don't know for sure. Please let me know if your dates or chemo regimen (x4, x6, dd, etc.) are wrong. I haven't projected very far ahead because I thought maybe some of the dates might change.

[Edited 10 years later to delete the blank box Photobucket inserted instead of our calendar, because my Photobucket account is no longer up-to-date. Really sorry about that...]

Hugs,

otter

[Note added in Edit: I've added beergirl (to whom I'll apologize for having to abbreviate her screen name to fit it in the column).]

Otter,

You are something else, girl!  All of this research and chart-making...how do you find the time?  You have my tx dates correct.

Thanks for keeping track of everyone - it's interesting to see where we all are.

Sue, I'm glad you weren't hurt, especially by the cart.  I almost passed out in Wal-Mart (day 5, tx 4) but the lady working the deli offered me some food and I felt better.  Hadn't thought that it might be dehydration.

My hot flashes are subsiding a bit this week, so I'm sleeping a little more.  I'm wondering how patient I will be this summer when the kids are home from school...

Hang in there everybody, 

Michele

Looks like I will be joining you on Saturday. I will get TC then with 3 more TX to follow every 3 weeks.  My oncotype DX score finally arrived at my onc's office. My score was 17. That did not make chemo required, but certainly made me uneasy.  When my onc went over the whole report with me (found out I am PR+ not PR-) I opted to do the chemo. I have been taking Femara for 4 weeks. At least I can rest easier knowing that I have done everything I could to stop this and prevent a recurrence. Y'all wish me luck and think of me on Saturday!

Otter, you have my projected dates correct.  Thank you for doing this.  My honeymoon with the first Tx lasted 36 hours and now I'm just hour to hour trying to figure out what is going on.  It is so CONFUSING keeping track of the various meds and trying to keep a record of what I'm experiencing so I can communicate with the nurse.  I think the worst right now is the chemobrain, can it really kick in so soon or is it the continued stress?  I have so much awe and respect for those of you doing this with children at home and those of you working.  This cancer is spoiling my retirement big time but at least I'm not dealing with job and dependent children. 

Karen, I'm with you on the port. At my first tx. I needed to give 4 viles of blood for a study I am in. Unfortunately, for some reason the lab didn't take it and the chemo nurses had to. It took 4 nurses and 5 needles to get through all the blood work and chemo infusion. Then they said I should get a port for the next time. I told them that I have only 3 more txs. I'll suffer. The problem was that the lab should have taken the blood they needed in the first place, but couldn't find me in the computer to confirm the chemo I was getting and they were afraid to stick me! Next time I'll know better. Luckily all the brusing is healed and my next tx. isn't till next Friday.

Otter, thanks for adding me to the list, I know I don't post often but I do read daily and I pray for you all. I have had many a laugh, and shed many a tear over everyone's ups and downs of this disease. The most present one being my impending hairloss. Tomorrow is day 14 for me. My dd makes her Communion on Sunday, so I am hoping it holds out till then. Otherwise I guess the wig will have to do.

Thanks everone for helping me get through this, I don't know how I could without this board.

Kim

Good morning, all...

I updated the TC chart and re-posted it on yesterday's page.  I added beergirl (lookslikeyouneedabeergirl), whose screen name I love 'cause there is a sweet, sad story behind it ... but I had to shorten it to fit it in the column.

Please let me know if I ever post something that is so wide that it makes your computer screen go crazy.  Sometimes people post web links or pics that are too wide and they run off the right side of the screen.  A post like that makes the lines in every other post on that page lengthen to fit the "new" page width, so everybody's posts run off the side. Anyway, stuff like that (when it's a pic) is easily repaired, so just holler.

Michele--how do I have time to make charts etc.?  The easy answer is that I'm retired.  It's only my dh and I at home (not even any full-time pets), and I really really hate housework, and the deer eat everything I plant in the garden so we don't have one (plus we're in the "extraordinary drought" region or whatever), and this BC thing has me very preoccupied.  That, plus the fact that I kind of like messing around on-line and reading medical articles, naturally takes me to where I am.  Once I finish chemo in June, I will probably revert back to my "other" hobbies, if I can remember what they were.

beergirl, I'm not sure the rules allow chemo to be given on a Saturday.  Isn't that supposed to be your day off?  Gosh, what will they do if you need a Neulasta shot the day after your chemo?  I guess they'll figure it all out.  It is good (yet bad, of course) to see you here, after all this time.  Let's each drop that first digit off our Oncotype scores (your 17 becomes 7, my 26 becomes 6) and get on with our lives, right?

I promise not to talk any more about how much better I feel, since some of you (notably collector) are in the worst of it.  I do think tx #3 hit me a bit harder than the previous ones, although #1 is a devil because neither we nor our oncos know how it will go.

I hatehatehate i.v. needles.  Kfalls, what the heck is going on with your veins?  Mine have been so very forgiving, and it's not because my skin is not sensitive to chemicals.  Put a dab of just the right "Bath and Body Works" lotion on me, and my skin goes crazy.  But for some reason--maybe the small i.v. catheters they're using, maybe exquisite technique--my veins have withstood the trauma.  I have two good veins on the back of my available hand, and the nurses alternate them.  Anyway, I think my crew is so accustomed to using veins that it is easy for them.  Somehow the nurses have even managed to 1) draw 2 tubes of blood for blood checks; 2) take my BP; and 3) insert and run my chemo i.v., all in my right hand/arm and all within about a 4-hr period, with no bruising.  (Boy, have I jinxed that one for next time!)

lilwebb, if you don't comb your hair a lot between now and Sunday (your day 16?), you might be OK.  Mine didn't "fall" out--it pulled out with combing and washing and fingers.  I worked on it every day, pulling away the loose strands so they wouldn't end up in the food etc.  By my 2nd tx ("day 22" of round 1), it was ball-cap bald; but that took a few days.  So, maybe pick out a pretty scarf to wear to church that day (if you're lucky, you go to one of those churches where women cover their heads anyway!).

Oh, this is too long.  When I feel good, I get really long-winded (as if that doesn't happen anyway).  ...sorry...

Hugs,

otter 

Hi everyone,

Just finished my 3rd chemo with the Abraxane, they can drip it more quickly so it was a shorter session. 

Deecsw - they'll probably give you a full dose of Benadryl the first time just to be safe, but if you tolerate the treatment you can ask them to do less the 2nd.  I've driven myself to treatment everytime.  The first time they dripped it in so slowly the Benadryl had worn off somewhat before I got back into my car.  So I think you'll be fine. Today I went grocery shopping after treatment - so it's not a show stopper. 

About ports.  For people making decisons regarding ports - I decided not to, and am glad I didn't.  I have good veins, and I'm only doing 4 - and I've been fine.  I didn't want another "thing" in my body after surgery - so consider your situation before you agree to a port. 

Sue K - my heart goes out to you with your passing out in the store.  Glad you are okay.

Otter - thank you for the chart - amazing work. 

Can I put in another plug for exercise as an additional way to ward off  SE's?  The day's I don't do "something" are always my worst days.  Not moving begets feeling worse begets more not moving.  I find if I just move, even when not feeling well - I just always feel better.

Also a plug for getting your hair buzzed before it starts to fall out.  For me, that was a positive move.  Got the wig fit and styled and I was ready - no waiting for the inevitable.  A way of taking control where I can...

May you all have comfortable days. 

Otter--yes, 6 treatments every 2 weeks does seem quite "dense." I am meeting with my nurse to go over everything next week and to get my scripts for the anti-nausea meds, etc., so I will ask her more about this regimen. As I read along here, I do notice that most who are doing this TC combo every 2 weeks are having 4 treatments, not 6. I will ask again why 6 is my "magic" number.

Trii-thanks for your input. As far as a port is concerned, I did not want one, but due to the lymphedema risk on my right side (had 12 nodes removed), and due to the fact that the only place they will put the IV is in my hand, I have no other choice. I have always been told I have "great veins," and I do, but unfortunately, they are not on my hand  :0(    I'm really getting scared now...how bad is the port placement? 

Back again ladies! I'm glad to see that everyone who's been checking in seems to feel pretty good these last few days. Kathy's over the rash thanks to the prednisone, and is looking forward to tx#4 next Tuesday. I mean, I guess she's looking forward to it in the sense that she will be one treatment closer to being done. Other than the rash and the usual exhaustion, she's handling #3 pretty well.

Otter, You have #3 and #4 correct on the chart. #5 is 6/17, and #6 and final is 7/8. Thanks so much for the work you've put into it, it really helps Kathy mentally to know that she is not the only TC x6 out there, there are 9 other ladies in the same club.

Uh oh, boss just caught me typing again, better get back to work. Minimal se's to all!

Steve

Hey All, writing from the chemo bar.  On my last "drink".  So far so good.  DH brought me a less than healthy lunch before I lose my taste and appetite, hamburger and chocolate shake.

Sharon S - I'm with you on the vacation idea when all this is over for me.  I have several weeks after final treatment before returning to work and am hoping to go some place peaceful and be pampered.

Beergirl - good to hear from you.  Will you be having a port put in or going to pray that your veins hold out?

Otter - it would have ALMOST been worht the penalty fee for changing travel plans but my hair is now gone so I may as well finish.  Earlier today I could see your chart containing all our names and treatment dates.  This afternoon there is a white blank space where the chart used to be.  Don't know if something happened after you editied the chart ot what.

Jisman - I haven't been in the Chemo life as long as you but have found the exercise does indeed help.  On my own I use our treadmill or walk the dog almost every day.  Yesterday I had a fitness test and got set up for the cancer exercise program, will go twice weekly x 4 wk then re-evaluated.

SQK - that was an unfortunate occurance in the grocery store.  Glad you ended up OK and your son not shaken.

Steve - greetings to you and Kathy.  Hurray for her and only one more treatment!!!

Lilwebb and Deecsw - Welcome!!