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

My Mom has been having low grade temperature (37.6 - 38C) for almost a week now. To make her feel better, she takes Ibuprofen 200 mgs  as needed (is this the correct drug of choice if someone has a fever? Or maybe, Tylenol?). I was able to take a peek on her lab results last week and today, it was 12. + and now 13.+. It is elevated, right?  She is scheduled to have a port placed tomorrow and very first dose of chemotherapy (Cisplatin and Gemcitabine) on Monday.  With the elevated WBC and low grade fever, is it safe for her to proceed with the port placement and chemotherapy?  I'm thinking anti-biotics as soon as possible. Will chemo be delayed because of these factors?

@PCL - Thanks for your advise. It seems like Y-90 has  a higher success rate in shrinking tumor/s, I wonder why my Mom's oncologist opted for systemic chemotherapy first. I wonder if he's aware that there's a 2-4 week "rest period" needed in between...

Thanks in advance.

2 (edited by PCL1029 Wed, 07 Mar 2012 18:51:26)

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

Hi,
Sorry to answer so late, I have just come home from my part time job tonite.
In general ,for an adult,the dose for ibuprofen  is 600 mg( 3x200mg or  3 of the Advil) every six hours as needed for fever or pain. If she cannot take ibuprofen because of stomachache, she can take Tylenol 500mg or 650mg every 6 hours as needed up to daily dose of 4gm maximum.
I do not understand the lab result you were referring to,Is it WBC ? or respiratory related like the rate of breathing?
Since you will see the nurse for port placement tomorrow, and as you know, I am only a patient and not a doctor, I will wait till what the nurse said but make sure you mentioned to them your mom has been taking ibuprofen or Tylenol for fever. Ibuprofen is stronger  in controlling fever than Tylenol, I took them with no problem while on Gemzar. Though the RN or the doctor may want your mom be on Tylenol when the platelet is low once the chemotherapy starts.
I cannot speak for your oncologist,why? But most people when they hear the word cancer,most likely they will see or refer to oncologist first,from then on,it is mostly up to them to refer you to the surgeon if they thought resection is the possibility or if not, they will start to treat the patient unless multidisciplinary protocol is established like the big hospital Mayo,MD Anderson or John Hopkins.then The patient will be evaluated by all sides of the treatment triangle,that included surgery,medical oncology and radiation oncology specialists.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

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

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

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

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

Thank you PCL and Marion for taking the time to reply.  The port placement was postponed today. My Mom's oncologist decided that temp of 38C and elevated WBC is a little concerning....they ordered blood culture and urinalysis. Based on yesterday's CT scan, there is nothing concerning in the lungs. My Mom's temperature has been normal today/tonight. Accdg to her onco, should everything be OK over the weekend, chemo will still push through on Monday via peripheral IV.

God bless.

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

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

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

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

Lorraine....I hope for the blood tests to show nothing of concern especially, since the temperature is back to normal. A cautious oncologist is exactly what you want in your corner. You are fortunate.
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

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

Hi all...My Mom received her 1st chemo today (Cycle 1, Day 1). Her temperature is normal but WBC increased to 15+. She was given 3 different anti-nausea medicines (IV Emend, Dexamethasone and Aloxi). She 1st received Cisplatin and then Gemzar. 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. I guess, it is  significant as to which chemo drug goes in first.

My Mom was prescribed a bunch of anti-nausea meds to take as needed (Zofran, Compazine, Reglan and Lorazepam). Any thoughts as to which medicine to take first, with least side effects?

Thanks in advance.

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

Lorraine,

My wife does the same chemo, Gemzar / Cisplatin. She has prescriptions for the same medications you mentioned.

She takes Zofran after each chemo session:

* One pill in the evening the day of the chemo.
* Two pills (morning/evening) on days 2 and 3.
* One pill in the morning on day 4.
So, six pills in total after each chemo session.

Zofran did a good job of controlling nausea in the first 3 cycles. My wife didn't need to take anything else for nausea. The main side-effect from Zofran is constipation.

Zofran alone could not control nausea in the last cycle (#4). My wife took Compazine during the day in between Zofran.

We have Reglan but she never took it.

IMPORTANT: You must not take Compazine and Reglan together. If taken together, they may cause serious permanent condition called tardive dyskinesia. It affects facial muscles and may result in uncontrollable lip smacking, chewing, puckering of the mouth, frowning or scowling, sticking out the tongue, blinking and moving the eye, and shaking of the arms and/or legs.

My understanding is that Compazine and Reglan are similar medications. You take either/or, but not both!!

My wife was prescribed Lorazepam as anti-anxiety medication, to help with her sleep. Not as anti-nausea medication. She took it for a while and then discontinued due to side-effects.

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

Thanks for replying Eli. My Mom's nurse instructed us to take Zofran 3 days after chemo. I guess the combination of the IV anti-emetics (same family as of Zofran?)  given to her pre-chemo should cover the 1st 3 days. However, the rest (Compazine, Reglan and Lorazepam) she can take.
Just this morning, she woke up fine and then headache started to creep in. Is this an "aura" to nausea. Will Compazine help?

Thanks again.

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

My wife also receives IV of Zofran and Decadron (steroid) before chemo. We got clear instructions to take Zofran pills as per schedule in my previous message, in addition to IV. Compazine as needed between Zofran.

That said, you have to follow the instructions given to you by your doctor or nurse. NOT what you read here. smile

My wife takes extra-strength Tylenol for headaches caused by chemo. She takes the first Tylenol pill 30 minutes *before* chemo, because she knows that headache is coming.

Sorry, I don't know if Compazine helps with headache.

11 (edited by PCL1029 Tue, 13 Mar 2012 14:37:18)

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

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.

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.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

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

@Eli - Thanks again. I'll offer my Mom Tylenol (or Excedrin, as PCL recommended in one of the forums).

@PCL - Thanks for all the info. My Mom's next round of chemo will be on Monday. I believe we'll be seeing her Oncologist before administration. I'll ask him about the study.

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

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.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

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

Hi! So far, so good with my Mom post-first chemo round. She has been feeling the need to sleep more. I guess this is better as opposed to being sick in the stomach or something.

@PCL -  Sorry for the late response. I understand what you mean about shorter infusion time. It was an hour shorter because the RN administered both the IV hydration and Gemcitabine at the same time. Anyway, we'll be seeing her Oncologist on Monday and I'll make sure to ask him about the rationale behind the Cisplatin first then Gemcitabine next.

Re: 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

My beautiful daughter, Lauren Patrice, will live on in my heart forever.

My comments, suggestions, and opinions are based on my experience as a caretaker for my daughter, Lauren and from reading anything I can get my hands on about Cholangiocarcinoma. Please consult a physician for professional guidance.

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

Hi all. My Mom just finished her chemo #2 today. So far, so good! Anyway, as expected Cisplatin went up first followed by Gemcitabine (I believe there's hydration pre-, in between and post).

@PCL - here's the link provided by my Mom's oncologist.http://www.nejm.org/doi/full/10.1056/NEJMoa0908721
It's a clinical study published in the New England Journal of Medicine.

@Pamela - I appreciate all the information you provided. I wish you and Lauren all the best as well.  Lauren is very blessed to have you fighting this battle with her.

God bless!