The 4th and 5th cycle of the FEC-T chemotherapy protocol

Nivestim, the culprit that gave me cold sweats, stomach cramps, diarrhoea!

Here are my experiences with Taxotere (Docetaxel):

Cycle 4 – 23^rd September 2016

My morning blood counts were fine, and thus, the next chemotherapy session proceeded as scheduled. The pre-medications were given, with the addition of chlorphenamine injection (Piriton) which made me quite groggy. Piriton injection was given together with dexamethasone to mitigate any allergy reaction towards docetaxel (Taxotere®) if any. I was really hoping that Taxotere is going to be better than FEC, because we are talking about single agent infusion as compared with 3 cytotoxic drugs at one go!

I requested for Emend even though my oncologist said I don’t need it! Well, I told him I already felt nauseous before I went for the blood test! Hence, I wasn’t sure if I would be able to cope with Taxotere without Emend! He relented and said ok! I am totally aware that this is not right, but at this point of time, I will do anything for not getting sick! Anything….

Taxotere infusion went well without any untoward incidents (touch wood!). I was feeling absolutely normal for the first 3 days and even went for a walk at the Botanicals Garden on Day 3! My energy level was normal and I thought “hmm….taxotere really gonna be a breeze!” Certainly not wanting to believe what I have read earlier about this super drug!  Luck was not on my side though...my energy level decreases steadily from Day 4 and remained low until Day 9.

As taxotere will be tough on the white blood cells,  3 Nivestim injections  on Day 4, 5 and 6 has to be administered.  A kind senior onconurse taught me how to administer the ready to use syringe on Day 4 at the day ward. It was uneventful but stomach ache and cramps crept in later in the evening which got worse in the next few days.

Day 5 was the worst day I have experienced so far! Right after I injected Nivestim myself at home, I grew weak, had excessive cold sweat and lose consciousness for a short while, all within 5 minutes! I was pretty sure I injected the substance into the subcutaneous tissues and not in the peritoneal cavity! gosh!

Like the cartoon character flattened down to a paper-thin state rolled over by a truck….I have to stay in bed most of the time since that self-administered injection, feeling really thin and weak like a kitten! Surprisingly, despite all that, my appetite remained the same!

I texted my oncologist about my condition rather “immediately” wanting to know if I will be in trouble. Luckily there was nothing to worry about and he told me to drop by the clinic the next day. I literally have to be on the wheelchair as I was too weak to walk to the clinic! Finally, after waiting for 3 hours, the doctor said, “I think you are allergic to Nivestim, I guess you don’t need to take the 3^rd jab today, but you have to come over next week so that we can monitor your blood counts.” For no apparent reason, I turned bright-eyed and bushy-tailed; I stood up with my wobbly legs and walked down the floors without assistance! Good riddance!

Muscle soreness at the spine and neck area came in on Day 4 and lasted for a few days, not too bad as analgesics were not required. I have long suspected that my pain threshold may be abnormal!

The stomach cramps, dear me, came in waves, followed a typical pattern, reaching a peak of agony, eases off and the cycle continued until you pooped! Ok, we are dealing with loose stools here and this lasted until Day 10! Imodium 3 times a day seemed to control the cramps, but toilet visits maintained at least twice or thrice a day!  

Red spots or petechia were observed on both of my hands on Day 3. I noticed my face were flushing red on the same day which lasted for 2-3 days.

Some hairs started to drop by Day 15, slight discoloration on the toe nails were noticed and eyes were slightly dry and I have to use eye drops occasionally. Skin looked a bit patchy on certain days but resolved somehow. No mouth sores or ulcers. 

The most important change I noted was that my fasting blood glucose readings went up to 6.5- 7 mmol/L on certain days. I understood that hyperglycaemia and glucose intolerance is a known side effect of taxotere, and whether this is transient or going to affect me permanently, there is still lack of data to conclude anything at the moment. Anyway, I tried to reduce intake of rice, wheat and high carb food to manage this side effect.

Some days I felt numbness on my hands and feet, especially at night, so I took neurobion (Vit B1, B6 and B12) tablet occasionally, which kind of helped.

Cycle 5 – 14^th October 2016

My white cell count was about 5.0 X 10³/μL which was surprisingly good despite missing the 3^rd jab last cycle! So, the next Taxotere infusion was given as scheduled. Nothing untoward happened, luckily. I was feeling normal and even went to a Japanese restaurant for dinner that night! I knew that was a false sense of security!

This cycle no filgrastim injection was given. I felt fine throughout the first 3 days, and as expected, on Day 4, I somehow woke up with muscle and neck sore, but still manageable without analgesics. Energy went down slightly but I was fine and totally functional! No stomach ache, no cramps and no sick days! Tiredness was there but you feel fine after taking a nap. So, now we know which the devil is!

I went for my 1^st blood test after a week (Day 8) and the white cell count was down to 2.0 X 10³/μL. The doctor prescribed a strong antibiotic (Ciprobay) for a week, although I thought it was unnecessary (I meant….the count was not critical…). As the doc said, “Better safe than sorry!” I was feeling normal and energetic even though the counts were low….

Surprisingly, I developed a delayed “extravasation” (according to the doctor and to my horror!) at the injection site. Itchiness and tiny blisters appearing on the skin but got slightly better after I applied a steroid cream. I was later prescribed with Reparil Gel, which supposedly works best, according to my doc!

Redness and blisters appeared a few days after Taxotere injection

On Day 15 the white cell count turned out to be 1.9 X 10³/μL! That was totally unexpected; the count didn’t increase a bit! Well, the truth is, taxotere’s nadir period is definitely between Day 8 to 14 in my case! Sadly, the doc will have to postpone my next cycle if the blood count did not improve within a week…..

Meanwhile, I have to increase my protein intake and whatever I could get hold of…..