Will chemo be delayed due to low grade fever and elevated WBC?

Hi Lorraine,

If your Mom is still getting headaches, it could be from the Zofran. My daughter took Zofran the first few times after chemo and had migraine like headaches. We stopped the Zofran and use Compazine instead and no more headaches. She takes Ativan at night to help her relax, but has also taken it for nausea. My daughter’s chemo regimen has recently been changed. She had been on Gem/Cis and 5FU for 12 rounds of chemo. Her doctor decided to take her off the Cisplatin and just use Gemzar and 5FU for awhile because Cisplatin was causing her platelets to drop and about every 4th time she had to miss chemo. He feels that she will be able to get her chemo every time because she won’t have this problem anymore and he feels the benefits of having chemo regularly is better than having to skip with the Cisplatin. Cisplatin must really be the rough stuff because this week she only had the 2 chemos and felt like a million bucks. Every time she had the 3 chemos she would be really tired and achy for 3 or 4 days. This time she never felt bad and went shopping all day wearing her 5FU pump and also went on a 2 mile walk!! I have worries that her chemo won’t be as effective, but the doctor said he will add oxaliplatin if things start getting worse. I am not a doctor, so I have to trust that he is doing the right thing. When Lauren had her 3 chemos it was always Gemzar first, hydration, Cisplatin, hydration, and then pump hook up. The Cisplatin is what made for a very long day. This time she was in and out in about 2 hours compared to 6-7 before. I wish your Mom all the best in fighting this disease. Take care and God bless.

-Pam

Hi,
Excedrin contains both aspirin and Tylenol when taking together,it will provide “synergistic effects” for the combo;in short, it is a little beter than taking either separately.
I also ask my oncologist about the order of administration of Gemzar and cisplatin;he told me it really doesn’t matter; most of the time if cisplatin given first;it may just because if given the cisplatin first,theTOTAL time of administration will be shorter for the patient for giveing bothe drugs. that all.
God bless.

Hi,
your wrote
“Her Oncologist ordered specifically for her to receive Cisplatin 1st as opposed to their usual routine of Gemzar then Cisplatin. This was also clarified by the nurse. Apparently, there has been a study/clinical trial done sometime in 2011 regarding this matter.”

In my opinion,the only regimen(Taxol/Cisplatin or oxaliplatin and carboplatin) that may use for liver or CCA is the only chemotherapy regimen that required a specific order of adminstration. that is Taxol first and cisplatin later for the maximum benefit.if you want ,you can go the the experience forum look under the chemo forum title:Hey percy,could you—-” and you will have a general knowledge about each chemo agent;also look under title”systemic chemotherapy” for the combination regimens; for controlling nausea/vomiting ,go to the adverse reaction and side effects forum look under:”suggestion for medication for nausea and vomiting “

I look up the oncology nursing handbook as well as a couple regimen protocols from univ. of Pitt and another univ. out patient chemotherapy clinic; and the hospital I had my chemotherapy before; All are giving the pre-med zofran first,then give the gemcitabine over 30 min;Iv 0.9% sodium cholide for hydration and then give you the cisplatin over 2 hours.;
sometimes longer. Inside the cisplatin bag;they also add the manitrol (a diuretic)to facilitate the kidney function to deal with the toxic effect that will caused by the cisplatin.And after you finish the whole infusion;they will ask a you to drink more fluids (4-6glass of 8oz) to help flush out the cisplatin and protect your kidney better.

When gemcitabine and cisplatin giving together they will have the so call “synergistic effects” for the combination of the two chemotherapy agents.

As you know I am not a doctor; I am only a patient,but I do not think the order of administration in CCA to give cisplatin first is that much a deal; I ,myself only will not change it since the order of administration that use now already provide the “synergistic effect” benefit and use for quite a long time.

However,the following link is very interesting and give you another opinion that support the current order of administration of gemcitabine first,then cisplatin.

http://www.cecilyadams.com/gemzar.htm

I love to know where your doctor got the idea; if you can find out the article for me,I appreciate.

God bless.

Lorraine, hoping everything goes well for your Mom and all lights are a green GO for Monday. Best of luck!

Lorraine….I don’t think that anything will change in regards to the upcoming appointment. It is not unusual for people to develop a low grade temperature. There is a possibility that it is related to the cancer – we call it “tumor fever”. Of course, I only suspect that to be the case with your Mom. Only the physician will know for sure. Good luck and please, keep us posted.
Hugs,
Marion