Chemotherapy After Colon Cancer Surgery

Chemotherapy is a nasty business. By their nature, the chemicals chosen kill fast multiplying cells. They effectively kill the bad cancer cells, but they also attack good fast multipliers. This includes platelets and white blood cells. Doctors devise a plan based on weight and height for the typical person of those dimensions, but of course no one is typical. They monitor blood numbers and side effects, and the plan is adjusted as necessary.

The plan for me involved 12 iterations of a two-week cycle. I was to have a blood test on Saturday. On Monday the oncology staff evaluate the numbers and compute the recipe. If all is well, I go in for an IV with most of the chemicals - from 3 to 5 hours. Then home with a 48-hour portable pump for the balance of the dose. On Wednesday I return for disconnect, and then recover for the rest of two weeks when it all starts over.

Doses 1, 2, and 3 were administered according to the plan, but then came the first hitch. Saturday blood numbers were too low, retest on Monday was still too low, retest on the next Saturday was still too low, but Monday was in range. Based on that reaction, the oncologist cut the dosage of oxaliplatin, the primary killer, to 3/4 strength and gave me dose 4 after 21 days instead of 14.

Because of the problem with number recovery, I requested blood tests on Monday instead of Saturday to maximize recovery. Dose 5 came off in 14 days. However, the next Monday blood test was too low again and dose 6 was postponed for a week. Because of the slow recoveries, a series of five shots of Neupogen to be self-administered daily starting three days after the chemo was prescribed. The shots really boosted white blood cells but they went down before the next dose so we changed to a 2 1/2 week cycle.

The 2 1/2 week plan was good for doses 7, 8, and 9 and up to dose 10. However, starting with 7 they added a 1/2 hour calcium/magnesium cocktail before and after the other chemicals, because neuropathy was setting in.

By the time I went in for dose 10, the neuropathy was quite severe. We all discussed the situation and decided to discontinue the oxaliplatin. This meant we could also discontinue the Neupogen shots and the calcium/magnesium cocktail. With this relief I sailed through doses 10, 11, and 12.

So I didn't quite meet the intended plan, but I did go through 12 cycles without severe damage to myself and if there were any bad guys in there, it looks like "the ox" and his friends got them!

Here's the summary - columns are dose number, days since last dose, amount of oxaliplatin, and comments. Comments include some actual quotes from Pono's e-mails.

1	-	Full	Blood test was OK. Side effects were there but minimal. I felt quite normal from Monday through Wednesday. Then Thursday through about Sunday I had a bit of nausea and fatigue. The nausea was easily taken care of with a pill (prochlorperazine). The fatigue resulted in lots of sleeping. The second week I felt a little stronger each day and was just about back to "normal" by the following Monday. "I feel quite well basically, but it's like everything I do is in slow motion. I have a terrible time starting projects or chores and sticking with them."
2	14	Full	Very similar to first period day to day, with a couple new things. On Wednesday after the IV removal, my legs and arms developed little red spots (possibly petechiae). I had blood work for platelet count and saw the doctors. The oncologist said the platelets looked OK and decided to wait and watch. The spots subsided. Nausea remained low-level but fatigue was a little more pronounced. Sensitivity to cold in the mouth, throat and fingertips was noticeable. Near the end of the period, this effect diminished. Great sensitivity to smells.
3	14	Full	"I had a fairly typical 2-week session except that the fatigue was deeper and the sensitivity to cold was more pronounced. All my mucus membranes feel like they will start bleeding if you look sideways at them. Chewing nuts or cookies is a scary experience. All the other side effects are still there but mild enough to deal with."
4	21	3/4	Having four blood tests before numbers were good enough to go resulted in a one week delay. Because of that, dosage of oxaliplatin was cut to 3/4 strength. "Each session is a little different. .... Fatigue was very deep and mouth sores occurred with the fourth dose. The other nuisance level side effects are always there, but tolerable."
5	14	3/4	"I think this last has been the easiest treatment so far. Still fatigued, but all the other side effects are very low level. By the way, I haven't lost any hair yet, but then I have very little left to lose."
6	21	3/4	"I think I mentioned the side effect of sensitivity to smells. I have found unscented hand soap, dish detergent, laundry detergent, and fabric softener, and they all help, but EVERYTHING smells."
7	16	3/4	"I have started to have neuropathy (numbness in the fingertips) so they added a 1/2 hour dose of calcium and magnesium salts before and after the office doses. Total of 5 hours in the chair yesterday."
8	19	3/4	"Side effects are really minimal compared to others with whom I have compared notes - I think I'm pretty lucky!"
9	16	3/4	"It was the worst yet. Fatigue was extreme but letting up now and neuropathy is deep and constant. Fingers and toes are numb. Turning pages and typing are very difficult. Opening boxes, cans and bottles is quite a challenge. Taking 500 mg B-6 daily for the neuropathy. That is 25000% of daily requirement! They give me indigestion and cause output of little B-6 bricks. However, I am basically functional and I can see the end."
10	19	None	"The oncologist, the pharmacist, the nurses and I discussed my condition at length, and based on my progressive fatigue and neuropathy we all agreed to stop the oxaliplatin - the really toxic component of my recipe. I received and will continue to receive the other two main elements, but the bad one and two of its supporting drugs stop, the calcium-magnesium before and after stop, and (joy of joys) I don't need to self-administer Neupogen any more. I was done in 2 1/2 hours instead of the usual 4 hours or more."
11	15	None	"As of now I feel pretty well, but still tired (low blood counts) and with annoying neuropathy in fingers and toes."
12	13	None	"There was no lightning or thunder, no bugles or harps. Just hugs all around and best wishes and I went on my way. Chemo is done! I'm left with a bit of fatigue, numb and tingly fingers and toes, some mouth and throat discomfort. Hopefully all of these side effects will go away, but the oncologist warns that the neuropathy may take a long time and may never go away completely."