Friday, September 7, 2007

Chronology of Bradley's Treatment, Part 2

Chemo #1 Vincristine/Doxyrubicin/Ifosfamide (VDI)
B had his first round of chemo out-patient in the onc's office. The staff there was very friendly and made him feel special. He felt great after the first day of his first chemo. The tumor started to shrink during the first round and his pain decreased dramatically. By the end of the round, however, he was constipated, nauseous and irritable. B liked being outpatient as was able to rest in his own bed afterwards and hang out with his Texas friends in the evenings. This boy had friends everywhere he went, for as long as I'd known him, an absolutely remarkable quality. The doxyrubicin was administered slowly, with a small portable pump to keep the flow steady. B carried around this pump for the four days of treatment. It made a high-pitched squeaky noise with every pump, which he found extremely annoying at night.

During this first round, we read the pile of literature from the oncologist and, over the course of the week and the one after it, we experienced the Ewing’s treatment lifestyle for the first time:

Week 1
Chemo week. During this week, B would have chemo in sessions lasting 4-6 hours daily for 2-5 days depending on which cycle it was. Managing the immediate side effects caused by the chemo was very tricky and required someone to be home with him all the time.

Week 2
This is the dangerous week, in which the following counts can drop to zero. The impact of chemo on blood components:

WBC White blood cell count. When this is low, he is susceptible to infection. Our orders were to take him directly to the hospital if his fever hit 100.2. Plan on being admitted and staying a few days.

RBC Red blood cell count. Red blood cells deliver oxygen to the rest of the body. When these were low, he was extremely tired due to the lack of oxygen being delivered to his organs and limbs.

Platelets Responsible for clotting. When platelets were low, he had to be very careful of injuries that cause bleeding, including internal bleeding. He’s not supposed to even floss his teeth then. Legend on ACOR has it that low platelets can also be responsible for extreme crankiness.

Mucositis is often referred to as “mouth sores”. That description doesn't convey that the inflammation and lesions encompass the entire digestive tract from the mouth all the way to the anus. It’s very painful and accompanied by high fevers & increased risk of infection.

Week 3
The Happy Week. With any luck, counts have rebounded and side effects diminished. This was a good week to travel, eat out and have people over, although we’d been warned to keep him away from old people and babies as they’re prime carriers of bacteria.

The Drugs

Chemotherapy Agents

Side Effect Management

Protect bladder

Protect/heal stomach and esophagus

Protect heart

Nausea - Take the nausea meds the night BEFORE chemo to stay ahead of it!
Zofran: He liked this one best.
Decadron: This one made Bradley sleepy and cranky
Penergan: Sleepy!

Naproxen sodium (RX-strength NSAID)

Pain management
Duragesic (fentanyl) patch
Morphine (MS-Contin)
Morphine sulphate
Percocet/Oxycodone APAP

Mouth Care
“Pink Magic”
Swish-and-swallow mouthwash for both cleaning and relief of mouth and throat pain. It’s a blend of Pink Liquid Benadryl, Liquid Maalox or Mylanta, Nystatin Liquid (RX only antifungal product) and Viscous Lidocaine 2% (RX only numbing product).

Swish-and-spit to reduce gum swelling and kill bacteria.

To treat Infection

Use of an antifungal is important to prevent mouth fungi. A fungal infection can spread to the lungs. In a weakened immune state, this can be a big problem.

Miralax, Benefiber, Colace
Enema’s not allowed due to risk of internal injury.
Ex-Lax not allowed as it causes food to pass before nutrients are absorbed.
Magnesium Citrate – Bradley said this worked best


To flush mediport

Help skin heal during radiation

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