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Archives for: October 2005

10/30/05

Permalink 11:48:50 am, Categories: Background, 126 words   English (US)

CBC's

Date Note WBC RBC HGB Platelets
Baseline (4.5-11) (4.6-6.2) (13.5-17) (150-450)
2/22/10 CBC's 6.4 4.36 14.6 160
8/25/09 CBC's 6.2 4.56 15.2 161
4/27/07 CBC's 5.6 14.6 183
2/2/07 CBC's 7.3 4.51 14.8 181
10/27/06 CBC's 4.7 15.2 193
4/17/06 CBC's 5.4 14 200
3/30/06 CBC's 4 3.89 12.9 187
3/20/06 CBC's 6 13.7 183
3/9/06 CBC's 5.3 12.8 182
2/22/06 CBC's 4.5 13.4 214
2/15/06 CBC's 3.8 12.3 254
2/6/06 CBC's 4.6 11.1 234
1/30/06 Checkup 2.4 3.11 10.0 124
1/25/06 Transfusion 3.9 2.68 8.58 121
1/23/06 B4+18 3 7.9 112
1/20/06 Transfusion 3.18 2.09 6.64 35.9
1/18/06 B4+12 4.8 2.47 7.8 17
1/11/06 B4+5 7.9 26
1/2/06 B4 Day1 3.4 3.25 10.5 176
12/20/05 A4+8 Hosp 2.6 2.7 8.5 88
12/19/05 A4+7 Hosp 2.0 2.82 8.8 92
12/18/05 A4+6 Hosp Hickman Pulled 2.2 2.08 6.7 104
12/17/05 A4+5 Hosp 2.9 2.28 7.3 136
12/15/05 A4+3 Hosp 1 Day 11
12/12/05 A4 Day4 6.9 2.71 8.7 207
12/11/05 A4 Day3 3.3 2.61 8.3 173
12/10/05 A4 Day2 2.2 2.28 7.4 146
12/9/05 A4 Day1 2.7 2.38 7.8 144
11/28/05 B3+13 13.1 2.72 8.6 43
11/26/05 B3+11 Hosp 8.3 8 19
11/25/05 B3+10 Hosp 3.5 2.61 8.1 19
11/24/05 B3+9 Hosp .7 2.28 7.2 5
11/23/05 B3+8 Hosp .2 2.04 6.7 11
11/22/05 B3+7 Hosp .2 6.8 20
11/18 B3+3 3.9 2.68 8.6 101
11/15 Chemo B3 6.1 2.69 8.7 202
11/14 Chemo B3 6.5 2.84 9.3 218
11/13 Chemo B3 5.7 2.82 9.1 237
11/12 Chemo B3 3.5 2.62 8.5 223
11/11 chemo B3 4.8 2.71 8.7 256
10/30 hosp/fvr 4.6 2.07 6.8 94
10/29 hosp/fvr 3.2 2.21 7.3 116
10/30 hosp/fvr 4.6 2.07 6.8 94
10/29 hosp/fvr 3.2 2.21 7.3 116
10/28 hosp/fvr 2.5 8.5 168
10/25 30.6 8.9 299
10/22 chemo A3 5.9 2.49 7.9 335
10/21 chemo A3 4.6 2.44 7.8 387
10/20 chemo A3 5.3 2.64 8.4 379
10/19 chemo A3 5.4 2.84 9 411
10/11 B2+11 27.9 2.86 9 75
10/9 B2+10 5 2.59 8.3 33
10/8 B2+9 0.6 2.9 7.2 47
10/7 B2+8 0.2 1.95 6.2 10
10/5 5.9
10/4 B2+5 1.6 5.8
9/29 chemo B2 5.2 2.36 7.5 173
9/27 chemo B2 9.3 2.58 8 188
9/26 chemo B2 3.9 2.78 8.6 179
9/19 33 9.4 122
9/7 Chemo A2 7.4 2.85 8.6 497
9/6 Chemo A2 8.7 2.83 8.4 473
9/5 Chemo A2 15.4 3.17 9.5 517
9/4 Chemo A2 9.4 2.9 8.4 440
8/25 B1+6 0.6 52
8/20 B1+1 55.8 3.99 11.9
8/18 Chemo B1 7.2 3.7 11.1 228
8/16 Chemo B1 5.4 3.96 11.8 169
8/12 11.8 4.51 13.4 124
8/2 A1+4 14 13 292
7/29 Chemo A1 7.1 4.48 13.4
7/29 Chemo A1 6.8 4.28 12.9
7/28 Chemo A1 9 4.05 12.4
7/27 Chemo A1 9.3 4.17 12.5
7/26 Chemo A1 8.9 4.4 13.4
7/25 Chemo A1 7 4.53 13.7
7/6/05 6.2 4.41 13.4
6/23/05 7.6 4.46 13.5
6/11/05 12.9 5.27 16
3/15/05 6.9 4.97 15.4

10/20/05

Permalink 01:13:54 pm, Categories: Background, 896 words   English (US)

What to expect/Do - for the newbie

Just got a new roomie that's just starting R-HyperCVAD, and it made me realize I should create a common list of things to do/expect - without having to read through all my entries... These are related to my experiences, and yours may differ.

- Keep a list of all the meds that you're taking - including the dosages - with you at all times. If you have to go to a hospital or a doctor for a fever, etc, they won't know what you're going through, so you'll have to tell them.

- Change your cell phone's screen to be an ICE message (In Case of Emergency). List your doctor, that you're going through chemo, etc.

- Hickman Care (while showering) - major thanks to Linda!!: When you're in the hospital, they make this 'window' to place over your Hickman site to keep it dry while you shower. At home, a much easier solution than making the window is to use Glad Press and Seal, cut to a larger size then your dressing (I pull off a section, and have to trim about 4 inches off the one side) press it to your chest, around the dressing, and then tape over the edges. Takes about 2 mintues tops (probably less), and it's MUCH easier to me than making the window.
- also if you're going to be doing activities that make you perspire (bike riding, running, etc), make sure your doctor/pharmacist sets you up with 2 dressing changes per week. Otherwise it just becomes too loose.

- I felt a bit nauseaus the first day or two after chemo. Don't hold out on taking the anti nausea pills - take them when you start to get the feeling. I never got sick, but by delaying the taking of the pills, I only prolonged a not-so-pleasant-feeling.

- You'll probably start losing your hair (head and facial) about 2 weeks out from your A cycle chemo. My choice was to shave immediately. I've heard you can have discomfort if you don't, and I didn't want to go 'spotty'. My other choice was to have some fun with it - try some new 'dos', take pics, etc. Likewise with any facial hair. I'm a guy and it didn't matter that much, for the ladies, I understand it's more traumatic, but there are usually resources available to you - make sure you talk to your onc or the hospital you're being treated at.
- oh, it doesn't completely stop growing, you'll still have to shave once in a while - which is annoying - either leave all the way, or come back!

- Keep up with the mouth care - especially on the 'B' cycle. Do the mouth rinses, etc. Sores can set in, and they're annoying - prevent them.

- To date, the administration of either cycle has not been that bad for me. Meaning, in the hospital, when getting treatment, I generally feel quite fine. (The worst was hickups during my first 'B' cycle.) The nadir (7-10 days after chemo ends), is when you have to watch. The 'A' cycle has been fine so far, the 'B' cycle is the one to watch out for. It causes your counts to drop more - and I've heard this from others. Be ready for neutropenic fever, which simply involves a trip to the ER, and possible a stay for a few days. If you know about it up front, expect it, and plan for it - it's really not a bid deal. Don't be afraid of it, they know what to do.

- DON'T BE AFRAID OF A BLOOD TRANSFUSION. I got 6 pints over a week, and 2 units of platelets. It may be part of your treatment. If your body needs it, you'll get it, and your counts will go back up. No need to be concerned - they test the heck out of the blood, irradiate it, etc. etc....

- I have been able to work while in the hospital (I work in computers so I do lot's of e-mail, computer based work, conf calls, etc - and I can do all that remotely). I've been able to go back to the office the day after chemo - and feel fine. Maybe a little out of it, but depending on your job, somehow all the work activity doesn't allow you to feel out of it - which is a good thing! (Works for me.) If you feel tired, you need to cut back.

- Low HGB (hemoglobin) counts are the thing that affected me most - from a physical standpoint. I noticed it when walking across NYC for meetings, or when climbing stairs in Penn station or subways. Watch your HGB counts and your activity. When excercising, use a heart monitor, as since you have less oxygen in your blood, your heart has to work harder to supply oxygen to your muscles. Meaning, if you work out as hard as you did before, your heart may be working WAY too hard. Polar sells some great ones cheap. You can get them at Dicks Sporting Goods (dickssportinggood.com) or Performance Bicycle (performancebike.com) - no affiliation to either....

- Colonoscopies are not that bad! You get sedated before, and the next thing you know you're in the recovery room. The worst part is not eating the day prior, and having to take something that will 'clean you out'. A prostate exam is far worse (IMHO).

I'll add to this as things come to me - or please send me comments if there are things I'm missing.

10/14/05

Permalink 07:09:49 am, Categories: Background, 1547 words   English (US)

My Treatment Protocol

R-Hyper CVAD
I'm taking R-Hyper CVAD, which will be administered in the hospital for 4-5 days, every 3 weeks, for 8 cycles.

R-Hyper CVAD (R-HCVAD/-Mtx AraC)

Cycle A Breaks down for me as:
1) Mesna IV all the time (incl 5 hours after Cytoxin) - for bladder protection
2) Decadron (Dexamethasone??) 40mg (IV) - daily - cortiosteroid
3) Cytoxin (Cyclophosphamide) (IV) at 10pm(started at night)/10am for 3 hours, for 6 cycles (s/b Mon-Tues, Tues-Wed, Wed-Thurs) - Chemo drug
4) Sodium Chloride with Potassium whenever the Cytoxin isn't running, They turn it off when it is - for hydration/electrolytes.
5) Rituxin on Day 4, after the Cytoxin.
6) Vincristine (??) s/b on Thursday (12 hours after last Cytoxin) - Chemo drug.
7) Adriamycine (??) s/b on Thursday (12 hours after last Cytoxin) - Cheomo drug.

Antibiotics - given daily
1) Diflucan (Oral) - Anti Fungal
2) Cipro (Oral) - Antibiotic
3) Acyclovir - Anti Viral
4) Allupurinol - Gout Prevention (when the cancer cells break down quickly, it can lead to gout if you don't assist the system)

Other
1) Kytril (Oral) - Anti nausea - given once daily during Chemo in the hospital

At Home
1) Neupogen - 1 shot daily (increase WBC count) Days 1-10 following chemo (through the nadir - low point)
2) Diflucan (Oral) - Anti Fungal
3) Cipro (Oral) - Antibiotic
4) Acyclovir - Anti Viral
5) Take temp 4x daily - anything over 100.5 - go to the hospital for neutropenic fever (take tylenol)

Cycle B for me is:
* Rituxan Day 1
* Methotrexate Day 2 over 2 hours - CHEMO
* Methotrexate Day 2 immediately after the previous Methotrexate over 24 hours - CHEMO
* Methylprednisolone Day 2 - Day 4 - Steroid
* Cytarabine (Ara-C) Day 3 - Day 4 - every 12 hours for 4 doses – CHEMO
* Eye Drops to prevent Pink Eye - a side effect f Ara-C - every 6 hours.
* Leucovorin Thurs 8/18 (orally) – moderates the Methotrexate levels, which need to be low to let me be released.

Drug overviews:

NAME: methotrexateBRAND NAMES: Rheumatrex, Trexall
DRUG CLASS AND MECHANISM: Methotrexate is classified as an antimetabolite drug, which means it is capable of blocking the metabolism of cells. As a result of this effect, it has been found helpful in treating certain diseases associated with abnormally rapid cell growth, such as cancer of the breast and psoriasis. Recently, methotrexate has been shown to be effective in inducing miscarriage, for example in patients with ectopic pregnancy. This effect of methotrexate is attributed to its action of killing the rapidly growing cells of the placenta. It has also been found very helpful in treating rheumatoid arthritis, although its mechanism of action in this illness is not known. It seems to work, in part by altering aspects of immune function which may play a role in causing rheumatoid arthritis.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Injectable: 25mg/ml; Tablet: 2.5mg (Rheumatrex), and 5, 7.5, 10 and 15 mg (Trexall).

STORAGE: Store between 59 and 77degrees F in a sealed container, avoid light.

PRESCRIBED FOR: Methotrexate is used for cancer treatment generally in higher doses than for other uses, and is often administered intravenously or intramuscularly. Methotrexate is used to treat psoriasis, an inflammatory skin disease, as well as the arthritis that occurs in 10 percent of these patients (psoriatic arthritis). It is also used to treat active rheumatoid arthritis in adults and children. It is also used to treat other rheumatic diseases, including polymyositis and systemic lupus erythematosus. Methotrexate has been used to induce miscarriage in patients with ectopic pregnancy.

DOSING: May be taken with or without food. For rheumatoid arthritis and psoriasis, the dose of methotrexate is given WEEKLY, whether by injection or orally. For psoriasis, the weekly dose is often divided into three doses given at 12 hour intervals each week. This has been shown to be more effective, as it relates to the natural growth cycling of the skin.

DRUG INTERACTIONS: Because methotrexate can cause serious liver disease, patients with alcoholism or liver disease should not receive it. Patients should curtail alcohol consumption while taking methotrexate. Methotrexate can suppress the body's immunity. Therefore, any symptoms of infection should be reported to the doctor. Patients with underlying immune deficiency diseases should not receive methotrexate. A dry, non-productive cough can be a result of a rare lung toxicity. Methotrexate can impair fertility, decrease sperm count and cause menstrual dysfunction. Safety and effectiveness has not been established in children.

PREGNANCY: Methotrexate should not be used in pregnancy, as it can be toxic to the embryo and can cause fetal defects and spontaneous abortion (miscarriage). It should be discontinued prior to conception if used in either partner. Male patients should stop taking methotrexate at least 3 months prior to a planned conception and females should discontinue use for at least one ovulatory cycle before conception.

SIDE EFFECTS: Methotrexate can be well tolerated, but also can cause severe toxicity which is usually related to the dose taken. The most frequent reactions include mouth sores, stomach upset, and low white blood counts. Methotrexate can cause severe toxicity of the liver and bone marrow, which require regular monitoring with blood testing. It can cause headache and drowsiness, which may resolve if the dose is lowered. Methotrexate can cause itching, skin rash, dizziness, and hair loss. A dry, non-productive cough can be a result of a rare lung toxicity.

GENERIC NAME: CYTARABINE - INJECTION (sye-TAIR-uh-bean)BRAND NAME(S): Cytosar-U, Tarabine PFS
Warning | Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage | Medical Alert

WARNING: This medication will be given where you can be closely monitored by your doctor because serious (rarely fatal) blood disorders (e.g., anemia, bone marrow suppression) have been caused by this medication. Liver problems may also develop. Notify your doctor immediately if you develop fever, unusual fatigue, nausea, vomiting, diarrhea, persistent sore throat, easy bruising or bleeding, abdominal or stomach pain, dark urine, yellowing eyes or skin, or mouth sores.

USES: Cytarabine is one of a large group of drugs known as "antineoplastics"; these drugs are also known as cancer drugs, chemotherapy, or "chemo". They are used in the treatment of various cancers to slow or stop the growth of cancer cells. A combination of different types of cancer drugs will often be used to achieve better results and minimize side effects.

HOW TO USE: This is a potent medication. Use it exactly as prescribed. Unless your doctor instructs you otherwise, drink plenty of fluids while using this medication. This helps your kidneys to remove the drug from your body and avoid some of the side effects. Do not stop using this medication, even if you feel nauseated or experience vomiting.

SIDE EFFECTS: Nausea, vomiting, loss of appetite, headache, itching, freckling, diarrhea, dizziness are common side effects. Using the drug on an empty stomach may help to relieve vomiting. Changes in diet such as eating several small meals or limited activity may help lessen some of these effects. In some cases, drug therapy may be necessary to prevent or relieve nausea and vomiting. Temporary hair loss is another common side effect. Normal hair growth should return after treatment has ended. Contact your doctor without delay if you experience any of the following symptoms: fever, chills, painful or difficult urination, chest pain, heartburn, difficulty swallowing, easy bruising or bleeding, black or tarry stools, blood in urine or stools, pinpoint red spots on the skin, joint/back/side pain, swollen feet or lower legs, sores in the mouth or on the lips, yellowing of the eyes or skin, dark urine, shortness of breath, bone or muscle pain, severe stomach pain. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Tell your doctor your medical history, especially of: kidney or liver problems, gout, infections, allergies (especially drug allergies). Contraceptive (birth control) measures are recommended for use in men and women while using this medication. A preservative (benzyl alcohol) which may be found in this product or in the liquid used to mix this product (diluent) can infrequently cause serious problems (sometimes death), if given in large amounts (more than 100 mg/kg daily) to an infant during the first months of life (neonatal period). The risk is also greater with low birth weight infants. Symptoms include sudden gasping, low blood pressure, or a very slow heartbeat. Report these symptoms to the doctor immediately should they occur. If possible, a preservative-free product should be used when treating neonates. Cytarabine is not recommended for use during pregnancy. Consult your doctor for details. It is not known if this medication passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription drugs you may use, especially of: medicines used for gout. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.

NOTES: This medication can lower your body's ability to fight an infection. Notify your doctor if you develop any signs of an infection such as fever, sore throat, rash or chills. Avoid touching your eyes or inside your nose without first washing your hands. Use caution with sharp objects like safety razors or nail cutters and avoid activities such as contact sports in order to lower the chance of getting cut, bruised or injured. Do not have immunizations/vaccinations without consent of your doctor, and avoid contact with people who have recently received oral polio vaccine. Regular doctor visits are important. Frequent blood tests will be done to monitor therapy.

Background

These are my trials and tribulations of R-Hyper CVAD treatment for Stage 4 Mantle Cell Lymphoma

At the start of treatment (7/2005) I was a 38 year old male in good physical condition who was diagnosed with Stage 4 Mantle Cell Lymphoma on June 14th, 2005. I chose to begin R-Hyper CVAD treatment in Hackensack, N.J., under care of Dr. Goy - previously of MD Anderson in Texas, and prior to that Memorial Sloan Kettering in New York.

Thanks to my brother Alex for setting up this Blog!!

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