Starting Chemo May 2008

This post tries to clarify an earlier one regarding one I posted saying we should avoid Vitamin C supplements both during chemotherapy and after. 

"Cara", a dietician at Memorial Sloan Kettering called me back. 

She said (paraphrased): There are a couple reasons for this recommendation but the most important one is that research shows that in vitro (in the petri dish!), bc cells take up Vitamin C and then use it for growth. Now, this does not provide evidence of what happens in the human body (in vivo) but it gives her and her colleagues at MSKCC good reason to recommend that women with breast cancer not take more than 100% of daily recommended value of Vitamin C. 

You can have as many fruits and vegetables as you want, as much vitamin C in whole food form as you like.

But stay away from Vitamin C supplements.  Vitamin C is so ubiquitous in our diets that you do not really need to take a vitamin C supplement.  If there is some vitamin C in the multivitamin that you take, though, it's okay to take the multivitamin provided it does not exceed 100% of the FRDI (federal recommended daily intakes) . 

I hope this makes sense. I "otter" be clearer.

Welcome Sharon!  WOW...I'm sure glad that you are now feeling better.  Neulasta is the BOMB and I'm glad you will be getting it from now on.  It does its job.

Today is day 15 for me, from first treatment, and I know that my hair will start falling out at any time.  Just watching and waiting.

Enjoy feeling fabulous!

~Adrienne

Sharon, just saw your post - so glad all is well after your neutrophil crash.  Neulasta/neupogen really do work wonders.  I've been on neupogen from the start of my chemo, and have had absolutely no wbc issues.  I'm still more conscientious than usual about germ exposure (I had to slap my hand the other night when I caught myself tasting raw cake batter), but it's nice not to have to be totally paranoid.  Keeping life as normal as possible (not to mention staying out of the hospital!) does wonders for one's spirit.

Linda

Thanks, Adrienne-I'm not anxious for the bone pain of Neulasta, but I'm buying Claritin and anything beats 5 days in the hospital!

Linda-Hi! I've always been bad about licking the bowl when I make brownies, etc., and I guess that's a no-no now! I'm also currently being a little phobic about washing my hands, but again, it beats the alternative!

Roxi-Thanks for the welcome! I've been jumping around here and on the TC only board for a few days, and have really gotten a lot out of my reading. I KNOW it will be a lifesaver in the weeks/months to come!

Sharon

Just wanted to say a quick "hello".

Tina - Glad it went o.k. and I hope you are sleeping right now. 

Robin - Thanks for the poolside check-in!  Glad it went well for you also. 

I can't remember if anyone is starting tomorrow...

Welcome Sharon and Linda, thanks for visiting - come back often! 

By the way, I found this website in case anyone wants to check it out.  It is Scott Hamilton's website devoted exclusively to chemotherapy, all kinds, not just for breast cancer. 

www.chemocare.com

'Night, all.  Sending "no se" thoughts to everyone.

Tina, Adrienne, Robin, everyone: Sorry I have been out of touch. But I have been reading faithfully, and rooting for people through the bumpy patches and cheering our successes and I define success to include being able to find humor in a Cosmopolitan experience or a man indulging his twinkie-love.  (Whoops, the latter sounded a little Cosmo, didn't it?)

I'm pretty good aside from some local drama which I will spare you here. Lets just say I'm not sure whether it is the chemo that has prompted the start of my hair loss, or the personal stress of the last 72 hours. But all things considered, I'm just dandy.  Sleepless, but dandy.  

First tx yesterday...long day 9 - 4:30. It was okay but so long. I was glad that my husband went with to take notes about everything. Got home, tired and stomach hurt. Up since 4....mind is a little fuzzy I think from getting up to pee all night. I felt like I was pregnant again:)

Tina, I also brought a rag magazine to the place. I actually did feel a little bad when the nurse came over as I was literally the youngest one there until probably the end.  I would tuck it away and then bring it back out when she left. Too silly huh?  Most of the people were in their 70s and 80s, and they sounded so bad. They put me in the corner which was nice to just get used to everything.

Hope you are doing good today.

Julie 

Kristy - I'm not sure what ANC is but I can give tell you what my reports were.

According to my labwork sheet:

Normal range for WBC is : 4.1 - 10.9

Normal range for Neutrophil # : 2.0 - 7.8

My numbers:

5/7 - day of first treatment:  WBC 4.9   Neutrophil # 3.4

5/14 - 7 day follow up bloodwork: WBC 3.0  Neutrophil # 1.9

5/21 - Treatment #2 - WBC 5.5  Neutrophil # 3.8

On the 5/14 follow up...while my numbers were just slightly lower than normal, they would've been much worse withouth the Neulasta.  The Onc nurses were very pleased with the 1 week numbers.  And my bloodwork numbers before treatment #2 were even higher than my bloodwork before treatment #1.

I'm very grateful that I had the Neulasta.  I hope this helps.

~Adrienne 

rockthebald - I'm so sorry that you have personal drama going on...like you really need it.  I was worried about you yesterday as we hadn't heard much from you...and of course we're pool buds so I feel its my duty to keep tabs on you !  I hope you can catch up on some sleep today.  Please take care.

~Adrienne

Addenda to the blood count discussion -

* ANC stands for absolute neutrophil count. 

* Some labs express in thousands/uL, e.g., 1.4 rather than 1400.

* Comparing Adrienne's post and mine illustrates the fact that different labs use different definitions of "normal."  (Hers: range of 2.0-7.8 for ANC, mine: 1.4-7.0.) 

(I know "normal" red counts vary by gender, am not sure about white counts.) 

Linda

My mind must really be in the gutter this morning, but Adrienne,  I cracked up when you listed the things you bring with you to chemo and concluded, "Oh yeah, and my husband!  I never know what I'll be in the mood for . . . "

All I could think was, "Wow!  I hope they give her a private room, or at least a secluded corner."

Linda

I bring my iShuffle. This time, I also brought the book "Would You Rather . . .". An etch-a-sketch.  

Something I added to the Tips for Chemo thread:  

My chemo bag which I haul around everywhere (another good job for a friend): Ask them to put together a small make-up type bag (say 4"x4"x6" or smaller) that you can move from purse to backpack back to purse or whatever that includes some of the stuff that's good to have on hand when you're out and about: digital thermometer, Tylenol, toothbrush, toothpaste, Breathsaver-type lozenges, chapstick, unscented hand lotion, eye drops, antibiotic ointment, Purell sanitizer or handwipes, Saltines or animal crax, Kleenex, thin cap to ward off any sudden chills. And maybe a maxi-pad in case of any port or drain mishaps.

(Why this stuff? Important to ward off mouth sores, avoid fever/monitor temp, chemo dries out eyes, mouth, skin; lack of nose hairs causes drippy nose.)

Kristy, I did a thread on Neulasta awhile back, but it was way too long. I included a graph of what the ANC does during chemo when you get a Neulasta shot. I'll go fetch that graph from Photobucket and post it here (as an edit to this post).  I'll be back in a few minutes, gang!

............[visualize otter, scurring around]...........

OK, here's the stuff that might answer your question about how quickly Neulasta acts to "boost" neutrophil production in the bone marrow. 

When it is first injected, Neulasta reaches a sort of "steady state" in the blood, and the concentration doesn't change all that much for the first few days.  The chemo drugs will be killing bone marrow cells during that time, but it takes a few days for the effects of the die-off to be detected in the blood.

That's because mature neutrophils that are already in the blood aren't affected by the chemo; but they normally die of old age in less than a week.  Since the "baby" neutrophils in the bone marrow have been killed by the chemo, the old ones aren't going to be replaced.  (Drat!)

Thus, the absolute neutrophil count (ANC) will start to decrease as the mature neutrophils die of old age.  For some chemo drugs like Taxotere, the drop in ANC begins around day 4 or 5 and reaches its lowest point (the "nadir") on day 7.  For other chemo drugs like Adriamycin and Cytoxan, the nadir occurs later--generally between days 10-14.

In the meantime, Neulasta (which is a neutrophil growth factor) will begin working on the bone marrow, stimulating it to make and release more neutrophils.  This release will bring the ANC back up, generally within 2 days after the nadir. Without Neulasta, the nadir would be much lower and the recovery would take a lot longer.

Heres a graph that shows the drop in ANC in women with BC being treated with Adriamycin & Taxotere.  Some of the women got one shot of Neulasta the day after chemo (triangles); others got Neupogen daily for the first week to 10 days after chemo (circles).  See how steep the decrease is, even with Neulasta or Neupogen, but notice how fast it comes back up.  (Fig. 2 from MD Green et al. Annals of Oncology 14:29-35, 2003):

Once the bone marrow gets stimulated by Neulasta and the ANC begins to come back up, there will be more neutrophils in the blood again. As they appear, the Neulasta attaches to them and will be removed. By the time the ANC is back to normal, there will be no more Neulasta in the blood.

That's it.  Any questions? 

otter

Happy friday everyone!

Funny you should be talking about blood counts I had to deal with that last night. I'v been feeling so good and thought i had sailed through this round, but have had a sore throat the last couple days and my temp was up from my normal , it had gone up to 99.4. I hummed and hawed about going to the doc seeing as the temp hadn't hit that majic # of 100, but sure glad i did , he did blood work and my counts were really low. I'm day 15 of tx.

WBC- 0.9  (my orginal count before chemo was 6.5)

Neutrophil - .05 

so last night had to go up to emrg and get a shot of Neupogen (Filgrastim) and stay for an hour so they could see if i was allergic to it or not, and have to go back to get one for the next 4 days. (i'm not brave enough to do it myself..wimp i know)     It just shows trust your instincts and listen to your body.

Do you get the aches and pains from Neupogen also ? 

So yesterday was the most eventfull day i've had .....hair coming out in handfulls and evening entertainment. Just part of the rollercoaster ride of life!

Hope everyone else has a wonderful side effect free Friday!

Angels - I'm on AC dose dense, & take Neupogen shots 8 days out of each 14 day cycle. I'm the epitome of a wimp when it comes to needles, & I've been able to give myself the injections, from the very 1st one! Neupogen may cause bone pain, & the severity can range from mild to excruciating, from what I've heard. My experience has been minimal pain on 2 different occasions (each of which only lasted one day or less), otherwise no pain - and I've now been through 3 cycles, so 24 injections! One thing that my onc told me is that you really want to be sure to space the Neupogen injections 24 hrs apart, at the same time each day (or night), because if you get 2 injections closer together, that can cause (additional) pain. So if you get off-schedule & get one injection later than planned, you should probably use that as the time for the rest of your injections for that cycle.