Dad started chemo Tuesday (Carboplatin & 5FU) - Drugs and Blood Count Questions

Linda3D

Dad started chemo Tuesday. He was there about an hour and a half and came home with a pump that will be removed Saturday. Doesn't got back again for about a month.

The drugs listed in the binder they gave him are:

Decadron
Aloxi
Pepcid
Carboplatin (400 mg)
5FU CADD (or CAPD) (7200 mg)

Found information about the drugs on the chemocare website so, as I understand it, Decadron is a steroid, Aloxi is for nausea (and Pepcid too, I think) and Carboplatin and 5FU are the chemo drugs.

Anything we should know about these drugs? You know, what to prepare for etc.

Also there was two things in the chemo binder the cancer center gave dad that no one mentioned so mom and I are wondering if they apply to dad's drugs.

The first was that you should drink a LOT of water after chemo to flush the drugs out of your liver and kidneys. As I said, no one mentioned this to dad so dad hasn't increased the amount of water he's been drinking. (Still only about a glass or two a day - of water. He's drinking 1-2 Ensures, 1 glass of V8 and a glass or two of iced tea and a cup of coffee each day.) The book did say that SOME chemo drugs can damage your liver and kidneys so mom and I are thinking dad's drugs don't. Should we be concerned about the amount of water dad is drinking? (Not that we can make him do anything differently but we could tell the doctors or nurses to tell him. He MIGHT listen to them.)

The other thing in the binder was that bodily fluids are toxic the first 48-72 hours after chemo. Mentioned things like closing the lid before flushing the toilet and double flushing. Also said to clean up any accidents (urine, vomit, etc.) wearing rubber gloves and double bagging any garbage from cleanup before putting it in the trash. (Paper towels, gloves, etc.) I tell you, this stuff can make you overly paranoid. Well, us, not dad. :-) Is all this THAT critical?

Speaking of phrases like "after chemo" and "during treatment"...the information I read on the Internet about the chemo drugs (or one of them) said that the side effects pretty much only last DURING treatment. What does that mean? As I said, dad went the cancer center yesterday for chemo and left with a pump which will be removed on Saturday. Of course the pump is pumping chemo into him from now until then. Is "during treatment" WHILE he is receiving the drugs and after the pump is removed Saturday it is no longer "during treatment" until the next time when we start again in April? What I'm asking is, as I understand it whatever side effects occur pretty much during treatment and stop pretty quickly after treatment. So IF dad starts having side effects such as nausea and diarrhea will they pretty much stop after Saturday because that's when the pump will be removed and he will not longer be receiving drugs (until April, of course) or since the drugs will be circulating in his body all that time (I'm assuming) is the time between when the pump is removed and when he goes back in April still considered "during treatment" and therefore still subject to side effects?

Last question: Complete Blood Count

This is what they wrote in the chemo binder:

WBC 7.65
HGB 10.8
HCT 34.9
Platelets 340
AGC/ANC 5.09

Tried to find out what this means on the Internet and am finding mixed information and nothing helpful.

I (think) I realize that numbers going up is better and that numbers going down is worse. Am I correct? Is there any other information we can get from this?

MOE58

I CAN HELP BEEN THERE DONE THIS
Hi, you never sign your name so I am not sure who I am talking to but welcome to CHEMO, during Jeff's Chemo, he had the same as your dad, well let me tell you about the 3rd day of chemo, your dad is going to feel like crap, his taste buds will disapper, he will break out with mouth sores, sometimes so bad you have to call the doctor for some medicine which is like a mixx of things in it to numb the throat, and help heal, while going through this you are so right you are not being over protected you do need to use the gloves, and yes flush several times, keep bathroom santized and if anybody I mean anybody comes over they need to use hand santisizer as you see once he starts chemo he will be very susceptibale to stuff, even a common cold can put him in the hospital, you are so following the book and thats what you need to do, if he spikes a fever you hae to call the doctor. You said your dad is a deacon in the church well I hope he is ready to miss some church cause he is on a very strong CHEMO and he will get very sick, and he won't be able to be out in public, long, he will have diaherra, and no it won't go away after this week of chemo, it pretty much stays around until the end. Your mother also needs to do dishes with DAWN ANTIBACTERIAL SOAP, this is what we were told, also in the bathroom he needs antibacterial soap, otherwise he will pick up germs, YOUR FATHER sounds very stubborn, like mine was during sickness, they are from the old school thinking they don't need this, but GOD is giving him another chance so he needs to follow orders.

If his blood count is down during the time he is to start chemo and that will be the WBC they will not do chemo these must stay up in order to do chemo, as chemo is attacking all the cells including his good cells, fortunately Jeff was always able to have chemo cause his blood count stayed up. But alot of people don't get too.

No you are not being paranoid you must do this, because if you don't i will guarantee you he will end up in the hospital, your father will become very hateful, lash out at your mother along with you, its a MEAN DISEASE, just remember this is not him its the DISEASE doing this, there was times my Jeff was so hateful I had to go in the other room just to cry.

Your father will loose all hair on or about the 15th day, this includes head, arms face private area, he will not like himself, and he will loose alot of weight. There will be times he won't eat, and he will tell you what he will want.

Keep alot of puddings, jello, oatmeal, ice cream, and hopefully you will have something close by for shakes, and alot of TOLIET PAPER.

you will need to try to get him to drink alot of water, if you have to buy the bottled water, you won't want to buy anything with acid, as this will not be good on his stomach, nor his mouth.

Sounds like you are doing everything right and reading the book, just get ready for this journey, because its not easy, but it sounds like YOU HAVE YOUR BIG GIRL PANTIES ON, you are just scared just like everyone else on this board was/is, if you go back to when I first signed on you will see many things I have asked,

Fortunately Jeff is doing good and coming up on a year anniversary since he was diagnosed.

This BEAST IS NOT FUN, but in due time you will ask yourself how in the heck did I get through all this with DAD, your will be amazed at what you can do when you least expect it. please know I hae walked this road and this journey exactly what you are going through and there is light at the end of the tunnel you just are at the beginning and have a ways to go.

If I can help let me know

Lori aka MOE

apalmleis

Some suggestions:

1. If you go to chemocare.com, there is a lot of information of the drugs, how they work, side effects, ect.

2. Carboplatin has renal toxicities, though not common unless there is underlying renal disease. Drinking fluids helps people stay hydrated. General rule of thumb is drinking at least 2 quarts of liquids/day, not gallons. With the chemo, people feel blah and tend to get dehydrated, which in turn make them feel works. If they are nauseated, it only gets worse on intake. If his urine looks concentrated/darker, then he needs more fluid. You might ask your oncologist how much liquid he wants your dad to drink.

3. Most side effects last 3-5 days, but it can happen later. This week I had delayed nausea starting about 4 days out after chemo and is now only starting to abate (day 8). It is difficult to say if the side effects occur, and depends on number of treatments, doses give, frequency and general health of the patient.

4. I never clean the toliet with rubber gloves after going. I use the master bathroom since that is where my reading materials. Our kids don't use the bathroom, they have their own. My wife was a heme-onc nurse, and she doesn't care (unless I smell up the place.)

5. Lastly, the chemo will effect other rapidly growing cells. The CBC is ok for chemotherapy, otherwise they would not want to give it to him. There are basically 3 lines that are affected. The white blood count (WBC), which are cells that fight infection. What oncologist are really looking at is the ANC (absolute neutrophil count), as neutrophils are the cells that fight bacterial infection. (other cells fight viral infections, etc). When this is low (< 1.0), your dad is at higher risk of infections, which is why you need to report any fevers your dad has to his oncologist immediately or go to the emergency room for evaluation. It is not something to wait until the next day, since the infection may have overwhelmed the system and can kill him. Your dad's oncologist will periodically check the ANC and if it falls to low, he may start shots which are daily that will boost the production of the ANC. The platelets are used in the body to stop bleeding. When they are low, your dad is at risk of bloody noses, bleeding gums, stomach bleeds, etc. Usually, bleeding issues do not become a problem unless platelets, are < 100, and more likely <50. If they get very low (rarely) < 10, he may get a transfusion. There is no growth factor for platlets, just time. Lastly, the HGB and HCT measure the red cells in your body. The red cells are cells that carry oxygen (think of them as boxcars) to the cells, and pick up CO2 to return to the lung. HCT is a percent of volume of red cells present. When you get a tube of blood drawn, it is mostly liquid, but in your dad's case, 34.9% is composed of RBCs. What is looked at more closely is the HBG, which is grams/deciliter of red cells (more accurate). Your dad's value is slightly below normal range, which happen as we get older as we make less RBC. When it gets below 10, then your doctor will ask more questions like how is his breathing, especially with activity, and how is his energy level. There are shots to help the boost the growth of RBCs if they get low.

Hope this helps.

Linda3D

apalmleis said:

Some suggestions:

1. If you go to chemocare.com, there is a lot of information of the drugs, how they work, side effects, ect.

2. Carboplatin has renal toxicities, though not common unless there is underlying renal disease. Drinking fluids helps people stay hydrated. General rule of thumb is drinking at least 2 quarts of liquids/day, not gallons. With the chemo, people feel blah and tend to get dehydrated, which in turn make them feel works. If they are nauseated, it only gets worse on intake. If his urine looks concentrated/darker, then he needs more fluid. You might ask your oncologist how much liquid he wants your dad to drink.

3. Most side effects last 3-5 days, but it can happen later. This week I had delayed nausea starting about 4 days out after chemo and is now only starting to abate (day 8). It is difficult to say if the side effects occur, and depends on number of treatments, doses give, frequency and general health of the patient.

4. I never clean the toliet with rubber gloves after going. I use the master bathroom since that is where my reading materials. Our kids don't use the bathroom, they have their own. My wife was a heme-onc nurse, and she doesn't care (unless I smell up the place.)

5. Lastly, the chemo will effect other rapidly growing cells. The CBC is ok for chemotherapy, otherwise they would not want to give it to him. There are basically 3 lines that are affected. The white blood count (WBC), which are cells that fight infection. What oncologist are really looking at is the ANC (absolute neutrophil count), as neutrophils are the cells that fight bacterial infection. (other cells fight viral infections, etc). When this is low (< 1.0), your dad is at higher risk of infections, which is why you need to report any fevers your dad has to his oncologist immediately or go to the emergency room for evaluation. It is not something to wait until the next day, since the infection may have overwhelmed the system and can kill him. Your dad's oncologist will periodically check the ANC and if it falls to low, he may start shots which are daily that will boost the production of the ANC. The platelets are used in the body to stop bleeding. When they are low, your dad is at risk of bloody noses, bleeding gums, stomach bleeds, etc. Usually, bleeding issues do not become a problem unless platelets, are < 100, and more likely <50. If they get very low (rarely) < 10, he may get a transfusion. There is no growth factor for platlets, just time. Lastly, the HGB and HCT measure the red cells in your body. The red cells are cells that carry oxygen (think of them as boxcars) to the cells, and pick up CO2 to return to the lung. HCT is a percent of volume of red cells present. When you get a tube of blood drawn, it is mostly liquid, but in your dad's case, 34.9% is composed of RBCs. What is looked at more closely is the HBG, which is grams/deciliter of red cells (more accurate). Your dad's value is slightly below normal range, which happen as we get older as we make less RBC. When it gets below 10, then your doctor will ask more questions like how is his breathing, especially with activity, and how is his energy level. There are shots to help the boost the growth of RBCs if they get low.

Hope this helps.</p>

Thanks
Everyone here is so great for taking the time to write all the information that you do. Once again I am overwhelmed by the generosity of taking the time to share knowledge and experience. Thank you so much. Printing this now to so mom can read it. Wish I could get her to start coming here but she says, "She can't deal with anything else right now."

Oh, for the record, my name is Linda. :-) Tried to change my user name here earlier today but it doesn't seem I can. I use Phaedrus everywhere else (or Parmenides320) but I have quickly learned that this is not really a "user name" kind of place. If anyone knows how I can change my user name please let me know.

Thanks again. Sounds like the calm may be coming to an end. (sigh) But hey, maybe we'll be the lucky ones! :-) At least we can be prepared.

Thanks again,

Linda

Unknown

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Donna70

unknown said:

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chemo
Hi Linda,
Bill has covered it all it seems but I like to mention that to prevent or lessen those mouth sores your dr can prescribe Acyclovir, I take the liquid form and it holds back those sores because you need nutrition and if they get really bad you cannot eat hardly. I am always amazed at elderly people being sent home with the chemo. I was a pretty spry 65 and at my cancer center they admit you for some of the chemos which mine was Cisplatin and 5 FU and give you continuous IVs during that time to prevent kidney damage. Even with all that, I developed neutropenic fever after my 2nd round and had to be readmitted for massive antibiotic infusions etc. So do the precautions they tell you and have your Dad take more liquids, if he gets really dizzy and dehydrated, he can go back to the center for IV infusions of fluids to help him out. Hoping he will be honest with you all and tell you how he is feeling and watch out for temp elevations, that is a sign of neutropenic fever which means your wbcs have gone way down. These are all serious drugs and some of the ones you mentioned are the pretreatment ones that help prevent bad reactions. take care and prayers for you all and your Dad!!
Donna70

Linda3D

unknown said:

This comment has been removed by the Moderator

Pump
William, you wrote, "Frankly, I don't see the wisdom of removing the medi-port before the infusions are complete. My doctor did not remove my port until 8 months after my Esophagectomy. The port can be used to administer other medicines as might be needed. It is not just a tool for giving chemo meds.

The port is to be flushed after the initial infusion is complete at the end of this week, but it does not have to be removed. Perhaps you misunderstood about its removal. That doesn't make sense to remove it. It is implanted in the chest.

Mention this to the oncologist and ask why he is going to subject your Dad to having to have the port put in yet again for the second infusion, which you say he will have later on. I would say that the port will remain intact "DURING THE ENTIRE TIME OF THE TREATMENTS", meaning it will NOT BE REMOVED until "AFTER" all treatments are completed."

The PORT is not going to be removed Saturday, the PUMP is. Sorry if I mixed it up.

Linda

Unknown

Linda3D said:

Pump
William, you wrote, "Frankly, I don't see the wisdom of removing the medi-port before the infusions are complete. My doctor did not remove my port until 8 months after my Esophagectomy. The port can be used to administer other medicines as might be needed. It is not just a tool for giving chemo meds.

The port is to be flushed after the initial infusion is complete at the end of this week, but it does not have to be removed. Perhaps you misunderstood about its removal. That doesn't make sense to remove it. It is implanted in the chest.

Mention this to the oncologist and ask why he is going to subject your Dad to having to have the port put in yet again for the second infusion, which you say he will have later on. I would say that the port will remain intact "DURING THE ENTIRE TIME OF THE TREATMENTS", meaning it will NOT BE REMOVED until "AFTER" all treatments are completed."

The PORT is not going to be removed Saturday, the PUMP is. Sorry if I mixed it up.

Linda

This comment has been removed by the Moderator

Unknown

unknown said:

This comment has been removed by the Moderator

This comment has been removed by the Moderator

MOE58

Linda3D said:

Pump
William, you wrote, "Frankly, I don't see the wisdom of removing the medi-port before the infusions are complete. My doctor did not remove my port until 8 months after my Esophagectomy. The port can be used to administer other medicines as might be needed. It is not just a tool for giving chemo meds.

The port is to be flushed after the initial infusion is complete at the end of this week, but it does not have to be removed. Perhaps you misunderstood about its removal. That doesn't make sense to remove it. It is implanted in the chest.

Mention this to the oncologist and ask why he is going to subject your Dad to having to have the port put in yet again for the second infusion, which you say he will have later on. I would say that the port will remain intact "DURING THE ENTIRE TIME OF THE TREATMENTS", meaning it will NOT BE REMOVED until "AFTER" all treatments are completed."

The PORT is not going to be removed Saturday, the PUMP is. Sorry if I mixed it up.

Linda

The Port
Linda,

Jeff still has his port and it will be a year on April Fools day, just about 2 weeks away, Just get prepared as when the treatments are over he will still have it, as this way they can put several things through this port, blook work, medicine, chemo drugs etc, so either way he has it for awhile, but yes it has to be flushed after every treatment and it has to be flushed every six weeks when the treatment is all done.

I hate to say this but I have walked everything you are talking about so every question you ask i have done it.

You are doing a great job, just PULL UP YOUR BIG GIRL PANTIES and know we are here for you.

If I can help let me know

Lori