Thursday, August 28, 2008

A/C Treatment and Taxol Treatment

For starters, I wanted to let those who know me, (or those who are praying for me) know, that I am feeling good this week. I have been able to walk almost everyday and work my full work schedule. I was even able to work my two house cleaning jobs. I had a lot to catch up on this week, due to the fact I was sick all last week. I was able to get the last of my to do list done this morning. My boy's all have hair cuts, they are ready to start school on Tuesday.

With that out of the way, I want to give a little information about A/C treatment and Taxol treatment.

A/C is one of the five most common types of chemotherapy given to women with breast cancer. It includes two drugs: doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). Paclitaxel (Taxol) or docetaxel (Taxotere) is added to A/C for women with node-positive cancer, or in women who've had a recurrence; it's delivered after you've finished the AC.

I'm sure most people think the worst about Chemo. That people spend most of their time with their head in a toilet throwing up non-stop, or they are so tired they can't get out of bed to even care for themselves.

Here’s the good news: That’s almost definitely NOT going to be what happens with with Taxol. The only bad thing about the A/C and the Taxol is how LONG a course it is.

1. What you can expect from Taxol:

You probably will lose your hair. (Probably around the second or third cycle.) Sorry. =( This is one side effect they haven’t made much progress on. As I posted before all of my hair fell out around the 25 day after getting the A/C.)

You will probably be nauseated, at least sometimes and at least a little. The “A/C” drug it is highly emetogenic, so most people do experience SOME nausea. People have differing amounts, however. I seemed to get more than my fair share of nausea, but I only threw up if I tried to eat. I fasted a lot before I started Chemo so I had to find out what worked best for me. Waiting 5 days after Chemo seemed to work really well for me. I drank a lot so I could keep up my energy level. I was still able to work and do things around my house. There are MANY excellent anti-nausea medications out there — they may not prevent every twinge, but if used properly you should DEFINITELY not be spending your days throwing up.

You will be tired. However, although "A/C and the Taxol causes fatigue, MANY people are able to work at least part-time through it, some even full-time. That should give you an idea about the fatigue. I walk for an hour most mornings and I work around 50 hours a week.

A/C and Taxol can cause some other side effects, too. The notable ones I experienced included:

Occasional mouth sores. Using the mouthwash Biotene helped greatly in this regard.

2. Don’t be afraid to ask for help.

If you’re suffering a lot with a side effect, don’t be shy about speaking up to your oncologist or nurse about it. Especially in the case of side effects like nausea, there are MULTIPLE drugs that can be tried. So don’t give up.

3. How did I feel after A/C, Taxol?

My experience was this. I’d get treated on Friday (say Friday the 1st). I would be sickest that Friday with a headache, nausea, and a generally ill feeling — think a bad case of the stomach flu. I felt best if I was laying down. Seriously — when you feel that terrible, your best bet is to try and sleep through it. Saturday morning was bad, but by Saturday night I often worked my Janitor's job. With the Taxol I take off the Friday of treatment and that is all. By Saturday morning I'm doing just fine. Sunday was an off and on again bad day, but I can eat with the Taxol Treatments. By Monday morning, I would feel well enough to do my normal day to day job. I have tried to walk each morning as much as I can. I feel better the days that I walk.

4. Frustration?

Most people seem to go through a period — often midway through treatment — where they get really frustrated and depressed. This is entirely normal, and it does pass, even though it is horrible to go through. Just focus on today. If you think about how long you have to go, you’ll just drive yourself crazy. TAKE ONE DAY AT A TIME!

Seeing my Oncologist

1. When I was taking the A/C treatment I had to see my oncologist every time I received Chemo. With the Taxol I receive it every week but I only have to see my Oncologist every other week.

I have a short office visit with my oncologist where she will feel lymph nodes, go over how she thought treatment was progressing, ask about side effects and try to address them, or discuss any test results. It is usually about a 10-15 minute appointment.

2. Blood tests: I have to get to the hospital 30 minutes before my Treatments so they can check my blood. I wrote all about this a few post back.

Your RBCs, to check for anemia, including your hemoglobin. If you are low, your doctor MAY withhold treatment, I'm still trying to keep mine up.

Your platelets. My platelets have been fine.

Your WBCs. They will especially focus most not on the total but on your ANC. What is ANC? ANC refers to the percentage of neutrophils (white blood cells that fight infection) and cells that will become neutrophils multiplied by the white blood count (WBC).

It breaks down as follows:
ANC below 2000 is considered to be neutropenia
ANC between 1000-1500 fairly low risk of infection. Chemotherapy will usually be given in this range, but not below it.
ANC between 500-1000 - moderate risk of infection
ANC below 500 - severe neutropenia - high risk of infection
They will also do a basic check of your electrolytes and kidney and liver functions before they decide to go forward with treatment.
Getting your counts depends on the speed of the lab; in general, I would have mine in fifteen or twenty minutes.

(If you’re too low, you’ll likely just go home and your oncologist will either wait for your counts to come up or he/she will start treating you with WBC boosters such as Neulasta. I never had a chemo delayed.)

3. They get your weight, blood pressure and Temperature, the oncologist writes the order, and the pharmacy makes it up.

There’s a formula based on weight and height used to calculate your chemo dosage — my oncologist weighed me each time and calculated the dose from there. The pharmacy then custom mixes your chemotherapy drugs. It used to take about 30 to 45 minutes to fill the order.

4. Pre-Meds and Fluids.

Because A/C and Taxol causes nausea and vomiting, your doctor SHOULD pre-treat you for nausea. If he isn’t, then I’d want to know exactly why. The “A” drug causes nausea and vomiting in over 90% of those who get it. Thus pre-treatment should be mandatory in my opinion.

It usually takes about thirty minutes to give your anti-nausea drugs. These are given via an IV drip. Some common ones include:

Decadron (a steroid — usually combined with one of the other drugs listed.)
I used to get Emend, with the A/C Chemo (a pill), then Aloxi and Decadron via IV. (My Port)

A tip! Emend costs like $360.00 for three pills. Make sure your blood counts are ok and you’re getting treated that day before you take it.

Along with the pre-treatment drugs you’ll likely be getting some fluids. The pre-treatment drugs shouldn’t hurt, burn, or cause any symptoms. They also don’t taste bad or anything like that.

Tip Two: Make sure your oncologist has given you a prescription for nausea. Anti-nausea drugs work best when used BEFORE you feel sick. The pre-treatment drugs should last about 12 hours, but after that you will take pills. I recommend taking it around the clock, rather than waiting for nausea to develop.

Tip Three: It’s helpful to have two anti-nausea drugs. Take one around the clock, and keep the other as a reserve for “breakthrough nausea” — nausea that occurs despite the other drug. And again, treat at the first twinge! Nausea is easier to control than it is to treat.

I had a lot of nausea with the A/C treatment, so that’s why so many tips on this part. it’s quite likely you won’t have as much as I had, but I think better safe than sorry.

Staying well-hydrated is very helpful.

You can bring a friend

This really helps the time go by faster. My Oncologist told me I needed to bring a driver for the A/C and the Taxol treatment because of the side effects to the Medication have to give me.

Chemo is usually given in recliner chairs — Your first Taxol treatment will be in a hospital bed. You will be in a room by yourself. You can bring your driver in.

If you have any questions, leave me a comment and I’ll try to get back to you ASAP. Also, if you think there’s something else that would be helpful to add to this post for future patients, please let me know that too!


LZ Blogger said...

Lori - My mother-in-law has been going through this... only now it is over for now and after her mastectomy and the follow-up procedures she has been given a clean bill of health for now. ~ I pray all is well for you! ~ jb///

Lori said...

Lz blogger,

I am sorry to hear about your mother-in-law. I'll be praying for her.

I have a bit to go but should be done with everything by mid-January. We will just have to pray and see after that.


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