Dexamethasone

[al from canada]

Happy holidays to all,
Just an observation: Quite a while ago my aunt died from Liver cancer. To clarify, she didn't die from cancer but from complications brought-on from muliple daily dosing of Dexamethasone, ie elevated serum glucose levels = diabetic coma. A couple months ago I came across a study that showed that Dexamethasone pre-meds with AC chemo had less effacy than AC alone. (since then I have tried to find this study without success: anyone help??)
When Linda got sick I was insistant that the supportive (anti-nausient) meds be kept to a minimum. Dexamethasone seems to be the pre-med of choice for most chemo regimes.
Since Linda has had chemo her blood chemistry has always shown high glucose levels, to the point where I ask the doctors if she was diabetic. I was told not to worry about it, that it is part of the course.
Two weeks ago, I asked the nurse to forgo the Dexamethasone pre-meds. Last week, surprise.... glucose in the normal range and no extra chemo side effects!
Dexamethasone has its value, ie to reduce swelling in brain mets etc. As well, we all know about the relationship between sugar, (glucose) and cancer.
I would love to hear some views about the use of dexamethasone as pre-meds.
Al

[Janet/FL]

Hi Al
Sorry not to have done my homework first, but is Dexamethasone the steriod that is used pre AC? I hate steriods. The nurse did mention that it was anti nausa, but didn't explain further.
Oncologist appointment tomorrow. Don't know what I will do. I will ask about this, though.
Janet/FL

[imported_Joe]

Dexamethasone is also known as Decadron which is notorious for its side effects and is known to cause elevated glucose levels.

In my opinion, oncs should give this drug only as necessary and for the shortest time possible.

Regards
Joe

[jeff]

Hey Al and all,

I know that when Rachel was getting taxol in the adjuvant setting they started her at one dose and reduced it each time until she was getting none of it. I think it's nasty stuff AND there is some basic science suggesting that it cuts into the efficacy of some of the most commonly used bc drugs (like Adriamycin).

Just my two cents.

Jeff

[Patty D]

Thanks for the heads up on the dexamethasone. I have been on mostly low dosages since Sept of 2003 for brain mets. I have tried getting off several times but the pressure and headaches were too much. Right now I am weaning off it hopefully for good. I havent had too much problem so far and hope I can get completely off it! I was not aware it could affect your blood sugar. I think this is checked monthly with my other blood tests but I will be sure to ask my onc if he has been checking it. I would assume he has and that it has been ok. PattyD

[Lolly]

I don't recall receiving Dexamethasone when I had A/C, I believe I was given Benadryl instead. And for nausea, Zofran or Kytril, and Promethazine pills for home. I think you're on the right track Al, I also believe "less is more", especially when a drug that may not be necessary is causing scary side effects. High serum glucose levels are worrisome.

Love, Lolly

[Sandy H.]

Hey Lolly did you do the picture yourself or did you have Joe do it for you? I like it and want to do one by my name. I enjoy seeing a picture with the post. Hugs, Sandy

[wlward]

Dear All
I managed to acquire avascular necrosis in my legs whilst on this. I hate it but it seemsed they said it helped with the side effects . I will ask for more details if have to have it again.
love
linda

[Lyn]

Hi, strange you should say that, when I fractured my shoulder and got avascular necrosis when it was undetected for 3 months, I was asked if I took steroids with my chemo, at the time I wasn't but when on the AC and Taxotere, I had my own bottle because 2 days was not enough I couldn't get up without it but when I was up I was buzzing, ate like a termite talked 10 to the dozen and was awake for days so this time when I had the Herceptin/taxol/carboplatin I was supposed to have it the day before in the drip and for 2 days after, I only had it in the drip I didn't want to look like a beached whale again and I didn't need it or any nausea drugs other than what was in my drip so don't know if I needed it then either. Now my avascular necrosis is described as arthritus and my shoulder is frozen.

Love & Hugs Lyn

[Lolly]

To Sandy about the picture; thanks, my husband took that this August, we were staying at the coast for our 30th anniversary! I sent the pic to Joe via my computer and he did the rest...I know he mentioned once before that if you even just have a regular snapshot, you can mail it to him and he'll make it a part of your "signature".

Love, Lolly

[AlaskaAngel]

Apparently some can do okay without it, and some have enough of a problem with the chemo that it may be more useful. I have seen a fair number of posts from women who have specifically requested prior to chemo not to have it and have seen no posts by anyone who did so and didn't do well... take that for what it is worth...

I was not knowledgeable about it at time of chemo almost 3 years ago to ask not to have it, and started with the standard dose. But I had such steady problems with vomiting that the next dose was doubled along with doubling the dose of Zofran. I did get through all of the chemo regimen but don't know if doubling the Zofran would have been enough without doubling the steroid, or whether I actually might have been okay without the steroid.

I also gained 25 pounds with treatment (18 of which is now gone...)

A.A.

[Jan]

I hate the effects of dex. I did all my chemo without it and did fine. (AC and taxol and herceptin.

[wlward]

Dear Lynne
It is strange - lucky my onc was on the ball and sent me to the bone dr. I was finished the taxol so needed it no more. The bone dr said it would probably correct itself over time as it was not in a joint thing. And it has reversed. I was lucky but am paranoid about going on it again. I wonder does the infusidon do different things to the tablets. Will you shoulder improve?
love
linda

[Lyn]

Hi there, apparently the only good thing would be when I can't stand the pain anymore I am up for a shoulder replacement, but I may end up loosing more movement than I already have, wouldn't you think with a new shoulder I would get a full range of movement, hopefully by the time I need it there will be something better, only reason putting it off is I was told it is very very painful worse than the origianl fracture so I am not dependent on pain killers and I was worried that my arm would die but nothing to worry about, at the moment so another wait and see.

Love & Hugs Lyn

[Lyn]

P.S. I didn't find any difference between infusion and drugs, at the time I just used to say giving me more drugs I was paranoid about keeping everything tidy so now I rather enjoy the day sometimes just doing nothing, instead of dusting. I used to feel flat for days if I didn't take them then but I found that weekly taxol is better than the big doses every 3 weeks or so, that maybe the answer.

Love & Hugs Lyn

[*_StephN_*]

Hi -
I am coming in a little late on this topic. But, my experience was that with my chemo they wanted me to have the Decadron(Dex) until it became apparent I could do with a smaller dose. There was a worldwide shortage at that time (Dec. 2000) so my med onc was willing to try the lower doses.
Getting weekly Adriamycin x 12, was a lot of Decadron, so that was cut and I had the Kytril as an injection into my IV line. Was not bothered by nausea at all.
With the Taxotere I had to have more - the two days before infusion and the day of. With my liver mets, I had Taxol and Navelbine each week and was also able to take half a dose or less. I was only given Benadryl as premed for the Taxotere.
The Decadron got me a little wired up - that was what I didn't like about it. And the restless legs twitches. I didn't like to take naps as I wanted to try to sleep normally at night.
Guess it is all in what the doc will allow, but doesn't hurt to ask for a smaller dose.