Premeds for chemo(taxotere,carb&Herc)

In "interviewing" 6 oncoologists before deciding the course I would take I focused on the chemo and hercep treatment. I never thought to inquire about the medications that they would dispense with the treatment. Naively, I guess I assumed that it would be standard.

I am somene who is extremely sensitive to most medications as well as numerous substances such as sugar, flour, wheat ,caffeine sweetners etc. My oncologist had me take 8 mg of Decadon twice daily the day before, of ,and after chemo. I was flying high and either the Decadron, Taxoter or Carb substantially increased my apetite. I asked if I could eliminate the Decadon and my Dr. was willing to take me to 4 mg from 8. About 2 days after chemo I have an insatiable craving for carbs which lasts for about 10 days. Relative to my Hercep treatments I originally was on 25mg of Benadryll which put me in a deep sleep. My oncologist reduced it to 12mg but is unwilling to take me off the Benadryll.

I attend a cancer support group and several of the women on TCH stated that they do not take Decadron or any other steriod with chemo. Further, another women who did a year of Hercp stated that she never took Benedryll or any other medications with Hecep. Further, several women stated that with TCH their oncologist ,as a standard course, gives them an injection with the drug (N?)to promote white blood cells within 48 hours of each chemo treatment. My oncologist has never prescribed this.

I have alot of shame relative to the 40 pound weight gain I have expereinced since the start of my chemo. My 6th and last round is scheduled for the last Thursday in May. I would appreciate feedback relative to the meds others are taking with their treatments.

[hutchibk]

It sounds like you have 4 different concerns.

1. Concern: You are very sensitive to many meds.... did your onc, his nurse, or the infusion nurse do a history with you for your chart prior to prescribing you Decadron or starting your first infusion? Did you ever volunteer to your onc that you had a history of sensitivity to many meds, either prescription or over the counter. The onc and/or nurses typically should acquire this information before treatments begin.

2. Concern: You are worried about weight gain and 'flying high'. The Decadron is known to have a side effect of excitability. This can be uncomfortable but can be mitigated with adjustment of dosage. Decadron is also used to increase appetite. That is one of the primary reasons it is prescriped with chemo. It also assists the anti-nausea drugs work more efficiently. It is preferred that you maintain or gain weight on chemo rather than lose weight/nutrition due to nausea, vomiting and lack of appetite caused by cancer drugs. Some of the weight should disappear on its own within a few months of discontinuing the Decadron. I did not "take" decadron orally with my chemo. It was infused at the beginning of each of my treatments. Many women do not pay attention that they have Decadron infused with their anti-nausea drugs during each treatment. So they may think it is true when they state "that they do/did not take Decadron" (which is not really steroid per se, it is a glucocorticosteroid, used almost exclusively for cancer treatment), but I am assuming that many of them have received it with their infusion, whether or not they have made a point to take note of what is in each little infusion bag. I would have them ask their oncs whether or not they had Decadron and I bet a large percentage of them would learn that they did indeed have Decadron with their treatments, just not orally.

3. Concern: Benadryl causes you to crash hard. I have the same sensitivity to Benadryl. But I also had an allergic reaction to Herceptin which was not pleasant (many women do have at least a slight allergy to some of the properties in Herceptin). We learned that I cannot handle an infusion bag of Benadryl or a "push" of Benadryl through a syringe into my infustion line. It hits my blood stream too fast and knocks me out. I don't like it. So, my infusion nurses noted in my chart to give me one oral Benadryl pill at the outset of each infusion (which I can handle much better, but does cause drowsiness) and it assisted me in taking a nice little nap for the duration of my infusions, but was not debilitating to me like infusion or push.

4. Concern: You are ashamed of your weight gain due to treatment. I am sorry that you feel shame and I would suggest that you frame it in another way... you are fighting cancer and whatever is necessary to get a leg up on this beast is worth it. If it means that you gain weight due to your treatment, then so be it. You can work to lose the added weight after you have completed the very necessary treatment. ALL of us gain some weight on treatment. It is not only due to the Decadron, but also from becoming more sedentary while going through treatment and by being forced into menopause due to the chemo.

I promise at least a little of the weight will disappear after you finish treatment. Then you need to force yourself to get as active as you feel good enough to handle, and slowly and methodically drop as much of it as you can. I gained about 23 lbs with treatment, lost about 7 of it from finishing treatment and have lost another 7 through mild to moderate activity and exercise. I remain with a net gain of about 8-10 lbs since treatment, but I know I can do more to shed that if I put my mind to it.

Don't beat yourself up! Talk to your doc about your concerns, but please know that you are not being treated inconsistently at all. Everything you have described is within the very normal ranges of standard treatment protocol.

[ElaineM]

Hi,
I would talk to the oncologist about those concerns, if I were not comfortable and experiencing side effects from the drugs.
Everyone's body is different. Everyone responds differently to drugs and drug interactions.
Good luck.

[Sheila]

Brenda is right on the money for almost everything....the reason you are getting the Decadron and Benadryl is to prevent a life threatening anaphalactic shock reaction that is sooooo common with the Taxanes...due to the base they are made with...I get IV push Decadron 8 mg and Benedryl 50mg IV push....I hate both, don't like the way I feel, I can't sleep and have gained 20# on this little cocktail...HOWEVER, I have seen a reaction from the Taxanes, and I will take feeling like crap and the extra weight anyday.
As far as the Herceptin alone, when I was on just Herceptin, I never had a problem, and never took any premeds....no Benadryl, NOTHING! Every center is different, but in Chicago, they do not give Benedryl with Herceptin alone. As far as the "shot" others have gotten, you will only get that (Neulasta) or (Procrit) if your counts start falling...hence the blood counts each time. If your counts are fine, no shots.
When you get off the steroids, and on the Herceptin alone, the weight will come off....its hard right now, but your life depends on these treatments...you will eventually get back to your old self.

[chrisy]

Brenda AND Sheila are right on target, as usual. I wish you had posted about this earlier in your treatment - as you can tell, many of us have various issues with the Decadron and Benadryl and could have offered suggestions earlier.

I did get the Decadron dose reduced (mine was given in an iv premed prior to the Taxol infusion) and that helped a lot. On the Benadryl side, you may be able to eliminate all premeds once you are on Herceptin alone. I never had any premeds with herceptin alone.

Unfortunately, I did have the weight gain and I can totally relate to the negative feelings that you describe. I'm still struggling with it, (the weight gain, that is) but then I've always struggled with it!

I like the way Brenda framed it, you are doing everything you can do to beat back this cancer - including taking on an undeserved weight gain.

On a different note, I'm proud of you interviewing 6 oncologists and that you are almost done with the toughest part of the chemo. Herceptin is not really a chemo as it acts differently - you know this already. You should definitely start to feel better on Herceptin alone!

Hang in there,
Chris

[BethC]

Hi,
I had TCH a few months ago and here is what meds I had:
Dexamethazone 4mg/2x a day starting the day before chemo. I continued it until day 8 because I had severe nausea the first round and that has an anti-nausea effect. It does make you gain water weight and real weight but comes off when you're finished. They also infused it into my iv, along with benedryl. They also infused tylenol into my iv.

After my first round of chemo, my counts dropped and I was admitted to the hospital with neutopenia. After that, I had to get a neulasta shot after each infusion (the following day). It made me feel lousy but it kept me out of the hospital. It is not prescribed unless your counts drop very low.

I am currently only getting Herceptin infusions and have no meds with it (no benedryl). However, I need to infuse it over 90 minutes instead of 30 because it reduces my side effects (coughing and bronchial spasms).

Every patient is different and tolerates medicines differently. Don't panic if your regimen differs from someone else's. Like you, I am very sensitive to medicines. Don't assume that eliminating Decadron will make you feel better - remember, you are getting really toxic chemical agents infused into your veins and they will make you feel weird.

Good luck with your last treatment - before you know it, you'll be finished with this part of your journey!

Beth

[Bill]

Hi Un! I can't add much to what has been said already. Hucklebuck(closet world-traveler) spelled out all of the issues pretty clearly. I'm not a doctor, but it seems like your dose of Decadron/dexamethasone is a little high, I could be wrong. D can definitely cause you to fly high and retain, but it's better to have reserves for your body to draw on than have nothing there when you really need it. And, you should not feel any shame from your weight gain. You are fighting a terrible disease and I'm certain that you are doing the best that you can. It doesn't matter what you are eating or drinking. It's the meds. that you need to take to fight this fight. I'm sure that you are still beautiful. You're in my thoughts and prayers, Bill