First FEC... "Freakin' Evil Compound"

So I had my first infusion of FEC on Tuesday, Oct 28. Let's take a step back and I'll tell you the side effects of each drug, like I did with Taxol way back when...

These were all copied directly from the sheets I got from the onc's office. Please don't sue me for plagiarism or copyright infringement!

5-Fluorouricil (5-FU)

Usually given intravenously

Often given with other chemotherapy drugs

Some of the side effects may include:

1. Nausea and vomiting; usually very mild
2. Bone marrow suppression
a. Red blood cells, white blood cells and platelet counts will all drop, reaching their lowest point (nadir) at 9-14 days after administration.
b. All counts will recover by themselves. No specific diet or activity will hasten this recovery.
3. Alopecia (hair loss)
a. Hair may thin, starting 2-3 weeks after administration.
b. Temporary; hair will return after therapy stops.
4. Loss of taste and appetite; both will return after therapy stops.
5. Stomatitis
a. Small sores progressing to shallow ulceration
b. May start as a painful tongue or generalized sore mouth. Notify nurse or doctor is you notice this.
6. Diarrhea
a. Notify the nurse or doctor is this occurs.
b. Doses may need to be decreased of therapy interrupted.
7. Skin Changes
a. 5-FU can make you more sensitive to the sun so wearing sun screen is important.
b. The palms of your hands and soles of your feet can become red, sore and cracked.
c. Use a good moisturizer daily on your skin.
d. Notify is of any ski irritation.


Epirubicin (Ellence)

Given Intravenously

Frequently given in combination with other chemotherapy drugs

Some of the more common side effects include:

1. Nausea/Vomiting
a. May start soon after administration and last several hours to several days.
b. You will be given anti-nausea medications prior to treatment, and you will receive prescriptions for home.
2. Myelosuppression/Bone Marrow Suppression
a. Your red blood cell (RBC), white blood cell (WBC) and platelet counts will all drop after Epirubicin, reaching their lowest point (nadir) at about 2 weeks.
b. This makes you more prone to anemia, infection, and bleeding.
c. All counts will recover by themselves. No specific diet or activity will hasten this.
d. Blood counts will be checked at least once each week and more frequently if ordered by your physician.
3. Hair loss
a. Hair loss is temporary. It will grow back after chemotherapy is completed.
b. Hair loss will start 2-3 weeks after Epirubicin is given.
c. Hair loss may be partial or complete.
4. Heart toxicity
a. Usually does not occur until high cumulative doses are reached. We will keep track of your cumulative dose and stop it before the high limit is reached.
5. Fatigue
a. Common with most chemotherapy
b. Usually lasts throughout the entire treatment time period
c. Light to moderate activity can help alleviate some fatigue.


Cytoxan (Cyclophosphamide)

Given intravenously or orally (I get it intravenously)

Frequently given in combination with other chemotherapy drugs

Some of the more common side effects include:

1. Nausea/Vomiting
a. May start 2-24 hours after administration
b. Mild nausea may persist while taking oral Cytoxan
c. You will be given anti-nausea medications prior to treatment, and you will receive prescriptions for home.
2. Myelosuppression/Bone Marrow Suppression
a. Your red blood cell (RBC), white blood cell (WBC) and platelet counts will all drop after Cytoxan, reaching their lowest point (nadir) at about 2 weeks.
b. This makes you more prone to anemia, infection, and bleeding.
c. All counts will recover by themselves. No specific diet or activity will hasten this.
d. Blood counts will be checked at least once each week and more frequently if ordered by your physician.
3. Hair Loss
a. Hair loss is temporary. It will grow back after chemotherapy is completed.
b. Hair loss will start 2-3 weeks after Cytoxan is given and is more likely with intravenous administration.
4. Cystitis (bladder inflammation)
a. May cause discomfort when urinating, frequent urination, or blood in the urine
b. To avoid, drink 3-4 quarts of fluid each day (especially water) for 2 days after treatment, and empty your bladder frequently.
5. Decreased Fertility
a. May cause absence of periods, decreased sperm count, or permanent sterility. Continue to use contraception.
6. Fatigue
a. Usually lasts throughout the entire treatment period
b. Moderate exercise, good nutrition and rest can help remedy fatigue.



So now that you know all that, let me tell you about it from a "real" person's perspective. It sucks.

I went to my infusion on Tuesday, and because I was nervous, Susan volunteered to go with me. Plus I knew I wasn't getting Benadryl, so I might get bored as I wouldn't be sleeping the entire time. We watched a movie ("After the Sunset," and not recommended) and ate snacks while nurses came in and out to give me different bags of stuff. The Epirubicin is red... and it makes you pee pinkish orange, kinda cool...

About as soon as we got home, I had a headache and some gnarly nausea. In a few hours, I was debilitated! It was like having a really REALLY bad hangover with out having had the fun of drinking tequila all night! I rested on the couch, but then woke up extra super hot and sweaty and moved to my room.

I had a little breakdown in my room just because I was feeling so crappy. Somehow feeling crappy makes this whole experience that much more real to me. I was having a whiny, self-indulgent, whimpy, babyish pity party, but I couldn't stop. I decided it was better to get all that out, especially while Susan was out so nobody would freak out (heh except me). I put an Ativan (the good stuff... for anxiety, nausea, and sleep) on my tongue and sucked on it to make it work faster. Then I gave myself a "get a grip" talk, and said "Carrie, you can do this. Stop being a baby and get it together. Get up, eat something, and feel better. You're acting like a loser." Or something like that. It helped, and I got up and immediatly ate a little cup of applesauce to get something in my stomach. Then I made myself a bowl of vegetable beef soup. I ate that and I think I pretty much went to bed.

Today I slept in. I made myself some toast (wonderful Mountain Rose homemade wheat bread, I might add) and an egg, ate it, and then went back to bed. I slept until my 2:00 appointment today. Sheesh am I tired! And my mouth has been super dry.

I went in to my onc's office today for hydration and a shot of Neulasta. Neulasta is a drug that is given by way of shot (ewww) that is supposed to make me have more white blood cells. The white blood cells are the guys who fight against infection. And when they're really low, a cancer patient can wind up in the hospital for something as simple as an eye infection. According to my friend, the drug was developed during the blood-tranfusion-and-AIDS panic of the 80's or early 90's (or whatever, I'm not a historian...!) and it is used instead of blood transfusions, which I find creepy. According to my nurse, it also helps me stay on schedule, which is of utmost importance to me because I cannot wait to be done and don't want to delay a single dose.

So now we're updated to today. I was feeling crappy until I left the onc's office today. They gave me some Tagamet to also help settle my stomach. Now I'm feeling better, but tired. I haven't taken a shower for a while because my nurse left the needle in my port yesterday so I woudn't have to get poked again today. And I haven't changed clothes because I felt like crap and it didn't seem to matter. And it didn't matter! So now I need to clean myself up and get ready for bed. I'm not sure I would say I feel good, but better is good for now! And who knows what tomorrow brings... hopefully more better and no worse, but it certainly isn't possible to predict.

I had Susan take pictures at chemo the other day so I could give you a step-by-step presentation of what happens. You can look forward to that later in the week!

Thanks for listening!