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Chemo side effects and possibly impaired kidney function
Dear Doctor,
Prior to her ovariancancer-induced obctruction, my mom, almost 70 years old, suffered from a misdiagnosed kidney impairment for a long time (the growth was around and in the urinary tract). Now she is on chemo (carboplatin and taxol) and suffering from vomitting, lethargy, feeling unwell generally and something I can only describe as "unwillingness or unability to speak much". We had earlier been assured by our physician that her possibly damaged (and only) kidney will be taken into account and function will be monitored. Now we are worried this may nto be the case.
When she went back to the clinic (during the weekend, which seems to matter in the clinics in our area) because of the side effects, pointing out her one existing kidney only, she was sent back home and not admitted to see a doctor. A nurse gave her a remedy to fight nausea or control stomach acid (I am not with her right now so I don't know which nor was she able to communicate elaborately). No tests were done . She already underwent this type of chemo as she had ovarian cancer 6 years ago, but her side effects then were down to slight nausea for one day--now she has been unable to keep much food and water for 3 days.
What is your opinion?
Thank you for any advice you may be able to offer!
Prior to her ovariancancer-induced obctruction, my mom, almost 70 years old, suffered from a misdiagnosed kidney impairment for a long time (the growth was around and in the urinary tract). Now she is on chemo (carboplatin and taxol) and suffering from vomitting, lethargy, feeling unwell generally and something I can only describe as "unwillingness or unability to speak much". We had earlier been assured by our physician that her possibly damaged (and only) kidney will be taken into account and function will be monitored. Now we are worried this may nto be the case.
When she went back to the clinic (during the weekend, which seems to matter in the clinics in our area) because of the side effects, pointing out her one existing kidney only, she was sent back home and not admitted to see a doctor. A nurse gave her a remedy to fight nausea or control stomach acid (I am not with her right now so I don't know which nor was she able to communicate elaborately). No tests were done . She already underwent this type of chemo as she had ovarian cancer 6 years ago, but her side effects then were down to slight nausea for one day--now she has been unable to keep much food and water for 3 days.
What is your opinion?
Thank you for any advice you may be able to offer!
I had a stent put in from my bladder to my kidney. Something lit up on the petct and it is pressing on the track. This stent will help with my kidney function and allow me to do my chemo treatments ... hope this helps
MEDICAL PROFESSIONAL
Hi There,
I think you are absolutely right to worry. Chemo is definitely adjusted to a person's weight and kidney function. So the dose is calculated according to those parameters. If she has renal impairment, she will be getting a lower dose of carbo. Taxol dosing is only based on weight - it is excreted through the liver, not the kidney.
Having said that, there are certain levels of renal impairment at which point one does not do chemo at all.
The information you need is what exactly is her renal or kidney function? The important lab test to know is the level of creatinine or "creat" fro short.
a level under 1 is normal
1-2 is mildly impaired
at a creat of 3, chemo should not be given
a level of 7 would be a dialysis level
Beyond that, it sounds like your mother is not doing well. Her performance status is poor. I am going to guess it is a 2 to 3 based on your description.
0 is perfect - working, no symptoms
1 is OK, working but having some symptoms
2 is too sick to work but getting out of bed
3 is spending at least 50% of time in bed
4 is bedridden
Finally if she is not able to eat or drink, she may need to be admitted for hydration and evaluation.
In summary
she need to have labs to check for anemia, electrolyte abnormalities and renal and liver function
she needs to be evaluated y a physician for possible admission for hydration
she needs to be ruled out for a bowel obstruction
please let us now how things go
take care
I think you are absolutely right to worry. Chemo is definitely adjusted to a person's weight and kidney function. So the dose is calculated according to those parameters. If she has renal impairment, she will be getting a lower dose of carbo. Taxol dosing is only based on weight - it is excreted through the liver, not the kidney.
Having said that, there are certain levels of renal impairment at which point one does not do chemo at all.
The information you need is what exactly is her renal or kidney function? The important lab test to know is the level of creatinine or "creat" fro short.
a level under 1 is normal
1-2 is mildly impaired
at a creat of 3, chemo should not be given
a level of 7 would be a dialysis level
Beyond that, it sounds like your mother is not doing well. Her performance status is poor. I am going to guess it is a 2 to 3 based on your description.
0 is perfect - working, no symptoms
1 is OK, working but having some symptoms
2 is too sick to work but getting out of bed
3 is spending at least 50% of time in bed
4 is bedridden
Finally if she is not able to eat or drink, she may need to be admitted for hydration and evaluation.
In summary
she need to have labs to check for anemia, electrolyte abnormalities and renal and liver function
she needs to be evaluated y a physician for possible admission for hydration
she needs to be ruled out for a bowel obstruction
please let us now how things go
take care
MEDICAL PROFESSIONAL
hi There
thank you for the follow up.
It sounds like you are doing a great job caring for your mother.
Alot of times when someone is very ill, every day is different. So it is a shifting target. It is helpful to have a point person in the doctor's office who can touch base with you daily or every few days.
In my office, I have my goddess nurse who does amazing phone support for my patients.
Another help is having a visiting nurse (VNA) who comes to the house to check in daily about issues.
As a general statement, chemo is hard but it is currently the only effective intervention that we have for ovarian cancer after primary surgery. The trick is to support the person through the chemo. Sometimes I do that by having my patients get home IV therapy for three days after chemo. Other patients come to the infusion unit for IV fluid. And rarely, some of my very fragile patients get their chemo as an inpatient so I can watch them overnight
best wishes
thank you for the follow up.
It sounds like you are doing a great job caring for your mother.
Alot of times when someone is very ill, every day is different. So it is a shifting target. It is helpful to have a point person in the doctor's office who can touch base with you daily or every few days.
In my office, I have my goddess nurse who does amazing phone support for my patients.
Another help is having a visiting nurse (VNA) who comes to the house to check in daily about issues.
As a general statement, chemo is hard but it is currently the only effective intervention that we have for ovarian cancer after primary surgery. The trick is to support the person through the chemo. Sometimes I do that by having my patients get home IV therapy for three days after chemo. Other patients come to the infusion unit for IV fluid. And rarely, some of my very fragile patients get their chemo as an inpatient so I can watch them overnight
best wishes
Dear Dr. Goodman,
Thank you so much for your reply!
My mom was given an apointment for a weekday to get an iv antimietic and fluids, and thus able to keep water and food, and was much better on the spot, changing from a stage 3 to 1. I am just still worried that these measures were only undertaken ca. 5 days after she first went to the clinic to report her severe nausea, thus exposing her to plenty of nausea and problems in taking and keeping dowm sufficient fluids in the meantime. Thankfully, the nausea didn't return after the IV.
A few days later, she came down with an an afternoon only high fever---very hard to spot when someone has no apparent symptoms other than napping nonstop and outside temperature is at 100 or so and we are all just dozing--which again made her unable to stay awake long enough to raise a cup to her mouth.
I also have the impression that his chemo is much stronger than the one we did 6 years ago, not only because of the nausea, but also her hair is falling out already, which happened much later last time. This worries everyone inthe family, that the symptoms are much more severe. Maybe also due to the summer heat?
Rushed her to the clinic where she was given an antibiotic, and her kidney values were taken the next day and labled as "ok", and her anemia at 3500. She was said to have an infection ( due to the blood work and fever) She had already been told earlier there was a tightering in her surgically created urinary tract--this was thought to be the cause of the infection. She used to have a stent there until before the chemo (which was said to have caused bacteria built-up) and already had to take antibiotics (forgot the name, the one they also commonly use for anthrax) 1 week prior to the first chemo. I read that taking antibiotics for urinary tract infestions isn't very effective and with that one, reoccurrences are the rule. Unfortunately she reacts with asthma and other problems to cranberry juice or anything remotely acidic in her throat and stomache.
She also ususally has diarrhea due to her ssurgically shortened colon--I am worried about smear infections, especially because she wears diapers for occasional surprise events at night. A nurse told us that shaving might help?
I now worry that with the next chemo, the tightening and the possible dehydration level with the next nausa wave, her infection will be right back, (if that was what caused the fever and not someone blowing his nose around the house, her drinking from my bottle accidentally etc.) and wonder what else could be done to prevent it? We already eat extremely healthy. Would zinc and vitamin C capsules help or is it dangerous with chemo? I'm positive that this helps me fight infections on the spur, but not sure how it is for someone with an impaired immune system either?
Your input is greatly appreciated!
Thank you so much for your reply!
My mom was given an apointment for a weekday to get an iv antimietic and fluids, and thus able to keep water and food, and was much better on the spot, changing from a stage 3 to 1. I am just still worried that these measures were only undertaken ca. 5 days after she first went to the clinic to report her severe nausea, thus exposing her to plenty of nausea and problems in taking and keeping dowm sufficient fluids in the meantime. Thankfully, the nausea didn't return after the IV.
A few days later, she came down with an an afternoon only high fever---very hard to spot when someone has no apparent symptoms other than napping nonstop and outside temperature is at 100 or so and we are all just dozing--which again made her unable to stay awake long enough to raise a cup to her mouth.
I also have the impression that his chemo is much stronger than the one we did 6 years ago, not only because of the nausea, but also her hair is falling out already, which happened much later last time. This worries everyone inthe family, that the symptoms are much more severe. Maybe also due to the summer heat?
Rushed her to the clinic where she was given an antibiotic, and her kidney values were taken the next day and labled as "ok", and her anemia at 3500. She was said to have an infection ( due to the blood work and fever) She had already been told earlier there was a tightering in her surgically created urinary tract--this was thought to be the cause of the infection. She used to have a stent there until before the chemo (which was said to have caused bacteria built-up) and already had to take antibiotics (forgot the name, the one they also commonly use for anthrax) 1 week prior to the first chemo. I read that taking antibiotics for urinary tract infestions isn't very effective and with that one, reoccurrences are the rule. Unfortunately she reacts with asthma and other problems to cranberry juice or anything remotely acidic in her throat and stomache.
She also ususally has diarrhea due to her ssurgically shortened colon--I am worried about smear infections, especially because she wears diapers for occasional surprise events at night. A nurse told us that shaving might help?
I now worry that with the next chemo, the tightening and the possible dehydration level with the next nausa wave, her infection will be right back, (if that was what caused the fever and not someone blowing his nose around the house, her drinking from my bottle accidentally etc.) and wonder what else could be done to prevent it? We already eat extremely healthy. Would zinc and vitamin C capsules help or is it dangerous with chemo? I'm positive that this helps me fight infections on the spur, but not sure how it is for someone with an impaired immune system either?
Your input is greatly appreciated!
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