Opinions about weekly chemo. Yikes!
Does adding weekly 40 mg. Cisplatin to rads just enhance the radiation side effects, or does it add some side effects of its own?
I'm post-surgery (June 30) and waiting to start rads in the beginning of September. Here's the thing. The major cancer center in Baltimore where I had my surgery allegedly presented my case to its tumor board. The recommendation was radiation, but I heard nothing about chemo.
After that, I went to another major head and neck center in Massachusetts, where their opinion was that radiation would probably do the job. However, their medical oncologist said I fell into a gray area where I should just do weekly Cisplatin to be on the safe side. She said I'd improve my chances of not having a recurrence by as much as 10%. Here's the crazy part: She said the chemo would give me NO side effects -- that it would only enhance the radiation side effects!
Next, I went to a third center and was told rads should do it, but that the medical onc. in Massachusetts was not wrong. If I really wanted to "up" my luck, I should do the weekly Cisplatin. Same thing about chemo NOT causing side effects -- just enhancing the radiation side effects!
Finally, I went back to the first place, and this time I said I wanted to see a medical oncologist. I found out that he had not been at my tumor board and he would have been the only medical oncologist there! His chair-side manner was quite different. He proceeded to scare the living daylights out of me with potential chemo side effects. He emphasized the toxisity, the potential hearing loss, the liver problems, the red and/or white blood cells potential problems -- you name it. When I told him what the other doc had said about the chemo just enhancing the rads side effects, he said, "She was lying." Then, he chuckled. Huh??
In the end, he told me to consider the chemo carefully, because it wasn't mandatory in my case. He did admit that it WOULD reduce my chances of recurrence by anywhere between 5-10%. That seems enough for me to get the chemo. My family certainly thinks so.
Does the chemo given at 40 mg., once per week during rads result in additional side effects, or does it just enhance the side effects of the rads? Any opinions from those who have actually experienced this?
Comments
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I had weekly Cisplatin
I did undergo weekly Cisplatin infusions in conjunction with my radiation. My medical oncologist did state that these infusions would definitely add to the effectiveness of the radiation treatments. He also stated that the infusions would amplify the side effects of the radiation. But, he also warned that Cisplatin in itself is a toxic drug. It has the potential to shut the kidneys down permanently in some cases. That is why when you have your infusion, they make sure they give you plenty of fluids during the process so you can quickly excrete this toxin from your kidneys. Also, it can make you very nauseaus for several days after your treatment. It also has the potential to cause hearing loss as well.
My weekly infusion consisted of 1 hour of fluids, then one hour of various anti-nausea meds, then a potent diuretic injection (better be next to the bathroom), then the actual Cisplatin for 1 hour and finally 2 hours of fluids. The diuretic causes you to pee continuously during the final 3 hours of treatment to make sure this toxin is flushed from the kidneys.
Just be sure to inform your medical oncologist of any changes you experience. Ringing in ears, dizziness, fevers, urination problems, joint or back pain, etc. All of these can be warning signs of the Cisplatin causing other issues. Also, one thing to understand is just like radiation, Cisplatin has the potential to cause another cancer.
It is hard for me to tell you whether or not the radiation side effects would have been less without the Cisplatin as I have nothing to compare it to. I just focused on making sure I stayed hydrated so as to ward off any long term kidney damage.
Hope this helps some.
Freddie
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Thank you, Freddie! It soundsFritz said:I had weekly Cisplatin
I did undergo weekly Cisplatin infusions in conjunction with my radiation. My medical oncologist did state that these infusions would definitely add to the effectiveness of the radiation treatments. He also stated that the infusions would amplify the side effects of the radiation. But, he also warned that Cisplatin in itself is a toxic drug. It has the potential to shut the kidneys down permanently in some cases. That is why when you have your infusion, they make sure they give you plenty of fluids during the process so you can quickly excrete this toxin from your kidneys. Also, it can make you very nauseaus for several days after your treatment. It also has the potential to cause hearing loss as well.
My weekly infusion consisted of 1 hour of fluids, then one hour of various anti-nausea meds, then a potent diuretic injection (better be next to the bathroom), then the actual Cisplatin for 1 hour and finally 2 hours of fluids. The diuretic causes you to pee continuously during the final 3 hours of treatment to make sure this toxin is flushed from the kidneys.
Just be sure to inform your medical oncologist of any changes you experience. Ringing in ears, dizziness, fevers, urination problems, joint or back pain, etc. All of these can be warning signs of the Cisplatin causing other issues. Also, one thing to understand is just like radiation, Cisplatin has the potential to cause another cancer.
It is hard for me to tell you whether or not the radiation side effects would have been less without the Cisplatin as I have nothing to compare it to. I just focused on making sure I stayed hydrated so as to ward off any long term kidney damage.
Hope this helps some.
Freddie
Thank you, Freddie! It sounds like you made it through okay. I hope I will be as fortunate.
The best information I have gotten about treatment has been right here on this board. I had hoped for more consistency between oncologists, but alas, that was not to be. Imagine my confusion when two out of three docs said Cisplatin would just make the rads side effects stronger! The only thing on which they were consistent was in telling me that adding the Cisplatin would decrease my chances of recurrence. And, wow, I didn't know that the Cisplatin, like the rads, increased one's chances of getting another cancer. It's a Catch-22, isn't it? I wonder if the Cisplatin raises that risk more than just going without it, in my case? It's something I should ask the medical oncologist.
I hope that the extra fluids and anti-nausea meds that they give will be enough to make this whole thing more bearable. Thanks for the input!
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Its rough!
I always felt bad for several days after the Cisplatin infusion. Just as you begin to start feeling a little better, then it is time for another weekly infusion. Do not be surprised if they have you skip a week. I missed one week (week 5) due to my platelet count being low. If it is low they do not want to lower it any further as you may not be able to clot your blood if you have a cut or bleeding from radiation. So believe me, it does more than just amplify the radiation side effects. It is a toxin in its own right. A few weeks after treatments, my blood counts and all returned to normal but still be sure to stay hydrated as to avoid any kidney damage.
I chose to do this as I too wanted to increase my chances of nonrecurrence to the highest level possible. Again, if you do choose this route, just make sure you monitor yourself and communicate any changes ASAP!
Freddie
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My husband had weekly
My husband had weekly cisplatin for 6 weeks. He was also in a gray area where he really didn't need it, per se, but the onc recommended it. His med onc also said that the side effects would likely not be severe. And honestly, aside from some mild ringing in the ears in the later weeks of treatment (which went away shortly after chemo was finished), my husband really had no other side effects. His blood counts were normal every week, he never once had a fever, no nausea from chemo, nothing. And he always went into work in the office the day after chemo too. He did have the typical radiation side effects though, but the chemo was no biggie. Other than being really time consuming (4 hrs total on chemo days including hydration).
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Cisplatin
I also had Cisplatin, but in three large doses spaced three weeks apart while getting rads. My oncologist was very upfront and said, "It's the chemo that gives chemo a bad name." But, he said research has shown to decrease the likelihood of a recurrence. He felt that cease of my young age and otherwise good health, I should go this route to give myself the best chances.
Honestly, I can't say that it increased the side effects of the radiation. My radiation side effects weren't all that bad until around week 5. The nausea was really well controlled for me with medication. The worst side effect was the chemo brain. For about a week after my infusions, I'd be lost in this fog. Very hard to concentrate or have conversations. Super fatigued and I slept a lot. Second and third week I'd be feeling better and then it'd be time for another round. By the final chemo, I was hoping that my counts would be too low to get my infusion because I was already so laid up by the rads. I did it, though, and survived. You'll get through this, too, and when it's done it'll seem like a blur.
Kari
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Cisplatin weekly here for 7
Cisplatin weekly here for 7 weeks though I missed a couple of weeks due to being too sick. I had pretty severe nasea from the chemo. I was also told that the chemo just helped the radiation be more effective and that it would help reduce the chance of reoccurance, which pretty much made it worth it. Other issues that I saw from the chemo was the stereotypical "chemo-brain" ,ringing in my ears, kidney pain, and general crappy feeling. Some things are hard to separate from the radiation as to what really caused it.
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Swopoe, it's interesting howswopoe said:My husband had weekly
My husband had weekly cisplatin for 6 weeks. He was also in a gray area where he really didn't need it, per se, but the onc recommended it. His med onc also said that the side effects would likely not be severe. And honestly, aside from some mild ringing in the ears in the later weeks of treatment (which went away shortly after chemo was finished), my husband really had no other side effects. His blood counts were normal every week, he never once had a fever, no nausea from chemo, nothing. And he always went into work in the office the day after chemo too. He did have the typical radiation side effects though, but the chemo was no biggie. Other than being really time consuming (4 hrs total on chemo days including hydration).
Swopoe, it's interesting how different doctors tell you very different things, isn't it? Your husband's med onc said the side effects would likely not be severe, and they were not. How wonderful! It's what the med onc at the first major cancer center told me, so it didn't worry me quite so much. It wasn't until the third doc, at a larger cancer center said she "was lying" (in those words), that I started getting worried. The guy who gave me the parade of horribles about side effects and toxicity is the guy who will be overseeing my chemo. :-O Sure enough, what he said was 100% listed as Cisplatin potential side effects. What I have read on this board just confirms it. A scary, but necessary risk.
I've been reading a book written by an oncological psychiatrist that is helping me a bit, and it says that chemo is nowhere near as bad as it used to be. However, I guess it would depend on many factors, including the dose, the type, and the duration, as well as the individual patient. I'm supposed to get 40 mg. of Cisplatin per week. I am going to use all the tips on the forum and hope for the best. Many thanks, and so glad that your husband did okay.
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Freddie, I am going to beFritz said:Its rough!
I always felt bad for several days after the Cisplatin infusion. Just as you begin to start feeling a little better, then it is time for another weekly infusion. Do not be surprised if they have you skip a week. I missed one week (week 5) due to my platelet count being low. If it is low they do not want to lower it any further as you may not be able to clot your blood if you have a cut or bleeding from radiation. So believe me, it does more than just amplify the radiation side effects. It is a toxin in its own right. A few weeks after treatments, my blood counts and all returned to normal but still be sure to stay hydrated as to avoid any kidney damage.
I chose to do this as I too wanted to increase my chances of nonrecurrence to the highest level possible. Again, if you do choose this route, just make sure you monitor yourself and communicate any changes ASAP!
Freddie
Freddie, I am going to be drinking water like crazy! I always carry around a bottle of water anyway. It's force of habit because we live in a very hot climate and I don't like the heat. With everything you have told me, I will be even more diligent. It looks like my first treatment will be Sept. 12 (a Monday - ugh!) and the appointment message says it's 4.5 hours. I guess they will hydrate me like crazy.
Did they usually schedule your rads around your chemo? They haven't given me the regular rads slot yet. My first simulation (I already had the mask made) is the Friday before, Sept. 9, but no word on future times. The chemo is at 10:30 a.m. Monday. Do they normally schedule the chemo before or after the rads? Does that matter?
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Thanks, Kari! I am going toKari2007 said:Cisplatin
I also had Cisplatin, but in three large doses spaced three weeks apart while getting rads. My oncologist was very upfront and said, "It's the chemo that gives chemo a bad name." But, he said research has shown to decrease the likelihood of a recurrence. He felt that cease of my young age and otherwise good health, I should go this route to give myself the best chances.
Honestly, I can't say that it increased the side effects of the radiation. My radiation side effects weren't all that bad until around week 5. The nausea was really well controlled for me with medication. The worst side effect was the chemo brain. For about a week after my infusions, I'd be lost in this fog. Very hard to concentrate or have conversations. Super fatigued and I slept a lot. Second and third week I'd be feeling better and then it'd be time for another round. By the final chemo, I was hoping that my counts would be too low to get my infusion because I was already so laid up by the rads. I did it, though, and survived. You'll get through this, too, and when it's done it'll seem like a blur.
Kari
Thanks, Kari! I am going to keep repeating that to myself. "I will survive this treatment." It really helps to read people's stories on this forum. There are days when I question how it will be, and if I am going to come through this okay. I'm told by the docs that I'm "healthy except for the cancer." lol The tumor is out, but the rads and chemo are "clean-up" to make sure we zap anything that might be left and clean up lymph nodes that were negative on a PET, but not dissected. Thanks for your encouragement! Best to you.
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On chemo days, my husband hadSylMarie said:Freddie, I am going to be
Freddie, I am going to be drinking water like crazy! I always carry around a bottle of water anyway. It's force of habit because we live in a very hot climate and I don't like the heat. With everything you have told me, I will be even more diligent. It looks like my first treatment will be Sept. 12 (a Monday - ugh!) and the appointment message says it's 4.5 hours. I guess they will hydrate me like crazy.
Did they usually schedule your rads around your chemo? They haven't given me the regular rads slot yet. My first simulation (I already had the mask made) is the Friday before, Sept. 9, but no word on future times. The chemo is at 10:30 a.m. Monday. Do they normally schedule the chemo before or after the rads? Does that matter?
On chemo days, my husband had rads and then would go upstairs to get the chemo and hydration. So it was all coordinated in terms of the schedule. Those days were an all day thing. We were lucky in that my mom was able to be at my house to get our kids on and off the school bus!
We also live in a hot climate, Houston, but my husbands treatment was from December-January. Still it is important to hydrate, especially with cisplatin. Drink fluids and go to the bathroom as much as you can. My husband had hydration on chemo days (Tuesdays) and also on Thursdays.
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EWadeLaw, wow... I'm so sorryEWadeLaw said:Cisplatin weekly here for 7
Cisplatin weekly here for 7 weeks though I missed a couple of weeks due to being too sick. I had pretty severe nasea from the chemo. I was also told that the chemo just helped the radiation be more effective and that it would help reduce the chance of reoccurance, which pretty much made it worth it. Other issues that I saw from the chemo was the stereotypical "chemo-brain" ,ringing in my ears, kidney pain, and general crappy feeling. Some things are hard to separate from the radiation as to what really caused it.
EWadeLaw, wow... I'm so sorry you had such a rough time. It sounds like your docs were on top of the situation, though, and knew when to give you a break. Were you given IV anti-nausea drugs and a prescription to help control your nausea?
Did your ears get back to normal after you were done with chemo? The med onc who will be overseeng my treatments told me that if I had hearing loss, it could be permanent, and that if I had kidney damage, that could be permanent too. The guy was just so filled with happy words! Seriously, my husband and I left that office with our heads spinning. And it takes a lot for that to happen. :-O
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I also had Cisplatin during
radiation....like Kari, mine came in the large dose every three weeks. I did get a little sick for about 3 - 5 days afterwards, then I'd have two weeks of feeling as good as I could considering I was getting rads. I had NPC, tho.....which meant that after rads were over, I had another 3 large doses of Cisplatin + a 4 day pump of 5FU. Considering how much Cisplatin I had, my side effects aren't bad. I have neuropathy in my fingers (that's the one that drives me crazy sometimes)....and ringing in my ears 24/7...which I seem to have gotten used to. My blood counts did get low during the treatment...I got many shots of Neupegen to boost my WBC's and a few transfusions to boost my hemaglobin....but that was in the last 3 months of chemo.
I'm of the opinion to hit cancer with a sledge hammer first time out....the weekly chemo's are of a lower dose....and I've seen many more people getting the weekly dose, rather than the 3 large doses over the last two years, which probably makes the side effects more tolerable.
p
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Yes, they did blood work eachSylMarie said:Swopoe, I'll be having my
Swopoe, I'll be having my treatments out-of-state, in Baltmore, but it's pretty hot there too, at this time of year. I will be drinking water like crazy.
Did they give your husband a shot of a diuretic every time he had chemo, toward the end of the session, to make him go to the bathroom? I read that somewhere. Yikes... More needles?
I read they do blood work each time, then do the treatment, then the diuretic. And me, with needle anxiety. I guess there will be some Ativan still left in my system after the rads. They gave me Ativan for the mask-making (it helped), and told me to use it with the rads until I get "used to" the mask.
Yes, they did blood work each time. He had the blood work done on Mondays so it would be ready for Tuesday and we would have to wait around anymore on Tuesday. My husband didn't get a diuretic. He was peeing enough as it was. He didn't need any Ativan, but i read that it does help some people with their anxiety.
I am originally from Baltimore...best of luck in my hometown!
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Rads before Chemo
I always had rads before chemo just because the chemo day was so long I was ready to scoot when it was done. Also, my chemo location had its own inhouse lab so blood work was done each day upon arrival, then met with the medical oncologist and if all blood work looked good, the party began.
I agree with Phrannie though in that I wanted to do I could to zap this cancer so agreeing to undergo the chemo was not too hard a decision.
Freddie
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All this Baltimore talkswopoe said:Yes, they did blood work each
Yes, they did blood work each time. He had the blood work done on Mondays so it would be ready for Tuesday and we would have to wait around anymore on Tuesday. My husband didn't get a diuretic. He was peeing enough as it was. He didn't need any Ativan, but i read that it does help some people with their anxiety.
I am originally from Baltimore...best of luck in my hometown!
is making me miss my steamed crabs with rock salt and old bay!
regarding needle sticks...if you are getting regular chemo, chances are they will put in a port so they don't have to do so many sticks for IVs. I read somewhere too to use crushed ice during chemo as it MAY minimize mouth sores.
My husband had full dose Cisplatin 2x during six weeks of rads, and then once after rads were completed in combination with 5 FU. Everyone will respond differently. The Cisplatin is a radiation enhancer - it helps the radiation effectively destroy the cancer. Some side effects may include nausea, fatigue and hearing loss.
chemo infusion does take a while. My husband worked on his laptop for some of it, and slept for some of it. I always brought along some work to do as well as snacks. Because he had a full dose of Cisplatin (100 mg) it affected his white blood cell count. He had neutropenia twice and landed in the hospital for it, even though he had Neulasta administered before the chemo. His case may be atypical though - his chemo doc once called him "a complication magnet"!
I'm pulling for you and hope all goes well.
Barbara
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Swopoe, I'll be having myswopoe said:On chemo days, my husband had
On chemo days, my husband had rads and then would go upstairs to get the chemo and hydration. So it was all coordinated in terms of the schedule. Those days were an all day thing. We were lucky in that my mom was able to be at my house to get our kids on and off the school bus!
We also live in a hot climate, Houston, but my husbands treatment was from December-January. Still it is important to hydrate, especially with cisplatin. Drink fluids and go to the bathroom as much as you can. My husband had hydration on chemo days (Tuesdays) and also on Thursdays.
Swopoe, I'll be having my treatments out-of-state, in Baltmore, but it's pretty hot there too, at this time of year. I will be drinking water like crazy.
Did they give your husband a shot of a diuretic every time he had chemo, toward the end of the session, to make him go to the bathroom? I read that somewhere. Yikes... More needles?
I read they do blood work each time, then do the treatment, then the diuretic. And me, with needle anxiety. I guess there will be some Ativan still left in my system after the rads. They gave me Ativan for the mask-making (it helped), and told me to use it with the rads until I get "used to" the mask.
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Hi, Barbara! I am definitelyBarbaraek said:All this Baltimore talk
is making me miss my steamed crabs with rock salt and old bay!
regarding needle sticks...if you are getting regular chemo, chances are they will put in a port so they don't have to do so many sticks for IVs. I read somewhere too to use crushed ice during chemo as it MAY minimize mouth sores.
My husband had full dose Cisplatin 2x during six weeks of rads, and then once after rads were completed in combination with 5 FU. Everyone will respond differently. The Cisplatin is a radiation enhancer - it helps the radiation effectively destroy the cancer. Some side effects may include nausea, fatigue and hearing loss.
chemo infusion does take a while. My husband worked on his laptop for some of it, and slept for some of it. I always brought along some work to do as well as snacks. Because he had a full dose of Cisplatin (100 mg) it affected his white blood cell count. He had neutropenia twice and landed in the hospital for it, even though he had Neulasta administered before the chemo. His case may be atypical though - his chemo doc once called him "a complication magnet"!
I'm pulling for you and hope all goes well.
Barbara
Hi, Barbara! I am definitely going to be eating crabs for as long as my mouth sores allow. My rad onc said he will be adding liquid Oxy to my Gabapentin as soon as the pain starts, and he has an algorithm app that I downloaded while I saw him this week, which will generate dose changes quickly, depending on my pain score. According to him, even with the weekly chemo, he thinks he can keep me drinking and eating pretty well through treatment because he has fine-tuned this thing. I guess we shall see, and I will report back. This guy is pretty amazing. He has focused a lot of study on pain/swallowing management over the years and thanks to good timing (finally, something went right), I am in his current study with this app. So, hopefully, crabs here I come!
Were you able to hang out with your husband during his infusions, or did they kick you out into the waiting room? I'm trying to get a handle on this whole chemo thing so that my husband will know what is expected. He will be working on his laptop remotely during our 7 weeks ahead and handling things via conference calls where necessary. If he can't be with me, he may as well do something else for 4.5 hours and not sit in a waiting room, although I guess it would be comforting to have him close by.
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I agree with you and PhrannieFritz said:Rads before Chemo
I always had rads before chemo just because the chemo day was so long I was ready to scoot when it was done. Also, my chemo location had its own inhouse lab so blood work was done each day upon arrival, then met with the medical oncologist and if all blood work looked good, the party began.
I agree with Phrannie though in that I wanted to do I could to zap this cancer so agreeing to undergo the chemo was not too hard a decision.
Freddie
I agree with you and Phrannie. My brain was just beng wimpy and looking for a way out, I think!
Luckily, med onc returned my call this afternoon and I asked him my questions. I feel better about moving forward with the chemo. He said that although there is a small risk of another cancer with Cisplatin, it is very small -- so small that I should not put it into my equation when considering the chemo treatment. He believes that the benefit outweighs the cost. Seriously, it was like talking to a different man than the one I met just this past Tuesday. The guy I met on Tuesday (same guy) was listing horrible side effects and telling me to consider the chemo carefully. He seemed to back off that position after I told him that the med onc at Massachusetts General had highly recommended it. I guess we will never know if he reconsidered based on Mass Gen's opinion (CYA, maybe?), or if ... Aw, heck, I don't know.
What I do know, is that now is the time to hit the cancer as hard as possible. Thank you!
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Thank you, Phrannie. I agreephrannie51 said:I also had Cisplatin during
radiation....like Kari, mine came in the large dose every three weeks. I did get a little sick for about 3 - 5 days afterwards, then I'd have two weeks of feeling as good as I could considering I was getting rads. I had NPC, tho.....which meant that after rads were over, I had another 3 large doses of Cisplatin + a 4 day pump of 5FU. Considering how much Cisplatin I had, my side effects aren't bad. I have neuropathy in my fingers (that's the one that drives me crazy sometimes)....and ringing in my ears 24/7...which I seem to have gotten used to. My blood counts did get low during the treatment...I got many shots of Neupegen to boost my WBC's and a few transfusions to boost my hemaglobin....but that was in the last 3 months of chemo.
I'm of the opinion to hit cancer with a sledge hammer first time out....the weekly chemo's are of a lower dose....and I've seen many more people getting the weekly dose, rather than the 3 large doses over the last two years, which probably makes the side effects more tolerable.
p
Thank you, Phrannie. I agree that the sledge hammer approach is the one that will give me fewer regrets later, quite frankly. I was just apprehensive and my brain was doing all sorts of calisthenics in an attempt to rationalize my way out of chemo. You guys on this forum are great at keeping things real. I appreciate that very much.
What you wrote about your chemo doses and the responses you had makes a lot of sense. I think they still do the three infusions at higher doses at some centers, depending on the individual situation. And there are people who still get nasty side effects with the lower weekly infusions, as you can see on this thread. However, it is what it is. It has to be done. It's time to put on my big girl pants.
Thanks for your encouragement!
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Hard Choice
Sometimes you need to make one of those hard decisions. My first treatment was with Radiation only because my cancer was very small. My second treatment was with both Radiation & Chemo. Sometimes I wonder if it was necessary to do because a year later it came back a 3rd time. I decided then not to treat and did some herb med from a Bush Doctor in Honduras.
I hope and pray that what every way you good it will be the best way
Tim
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