Xeloda and Bleeding

[Tupelo honey]

I have one round of Xelox left, but have been having a great deal of trouble with increasing tenesmus and gastrointestinal bleeding and blood clots the last few rounds. I self reported this to Oncologist 2 rounds ago, he said it was late effects of radiation and would go away after I was done.

Meanwhile, I lost at least a pint or more blood / blood clots rectally this last round (killing my hemoglobin and platelets in the meantime), severe enough I was told to go to emergency room. They told me to keep taking the Xeloda but I have had trouble taking Xeloda as prescribed this round. I have to go off them every three days or so to heal and then when I restart, the effects come again, three days later. Not only am I compromising my treatment, which bothers me ALOT, the pain and inconvenience of the tenesmus (at least 50 trips to bathroom between 11:30pm to 3am last night, mostly for non productive "pushing" my rectum insisted on) is terrible.

I have not seen anything about this on the forums. Anyone familiar? I'm not sure what my doc is going to recommend for the last round this coming week. I don't have a port and have done all oxi by vein, and I was wondering of 5fu boluses are easier on the digestive system than the pills.

Thank you for any suggestions to take to my doc. And thanks for all the that I have learned so far from you all.
I

[Tupelo honey]

If anyone is curious, my last chemo was deferred until I had a colonscopy, the results are hemorrhagic radiation proctitis, a late radiation effect:

Marked edema of the rectum to the level of the colorectal anastomosis.
The rectal mucosa is characterized by pallor with intense friability, and
multiple large oozing telangiectasias. Areas of active bleeding were treated
with argon plasma coagulation (Effect 2, Wattage 25, Flow 1L/min)

Followup is sucralfate enemas, hydrocortisone suppositories and possibly repeat flexible sigmoidoscopy for additional argon plasma coagulation as needed.

[WriterGirl1969]

Hi Tupelo
I am on Xeloda, but have not had bleeding. This might support what you were told by your Oncologist. However, I have colon vs. rectal, which is a difference.
I'm sure some others with more appropriate experience will chime in.

--Tracy

[mypinkheaven]

If anyone is curious, my last chemo was deferred until I had a colonscopy, the results are hemorrhagic radiation proctitis, a late radiation effect:

Marked edema of the rectum to the level of the colorectal anastomosis.
The rectal mucosa is characterized by pallor with intense friability, and
multiple large oozing telangiectasias. Areas of active bleeding were treated
with argon plasma coagulation (Effect 2, Wattage 25, Flow 1L/min)

Followup is sucralfate enemas, hydrocortisone suppositories and possibly repeat flexible sigmoidoscopy for additional argon plasma coagulation as needed.

I had read your original post, but just didn't have any advice to give you - other than asking if your oncologist knows about the supplements you are taking.

I'm sorry you've been going through such a hard time and I'm glad you're being taken care of now. I hope you're feeling better soon.

[Tupelo honey]

I had read your original post, but just didn't have any advice to give you - other than asking if your oncologist knows about the supplements you are taking.

I'm sorry you've been going through such a hard time and I'm glad you're being taken care of now. I hope you're feeling better soon.

Thank you. I appreciate it!

Yes, My doctor has approved all my supplements, although I doubt that he, was well as I, truly comprehend the interactions possible between them. For instance, cimetidine can contribute to ulcerative colitis - something I did not know until I started researching what was wrong with me. I discontinued it, as well as aspirin, because of that. Curcumin is an antioxidant, though highly recommended to use due during chemo due to its other actions, including destroying colorectal stem cells. It was approved by my doctor for used during chemo, but I used it for half of chemo only, trying to get the best of both worlds. I discontinued modified citrus pectin when I ran out last time, about 2 months ago. And, I quit all supplements several weeks ago, when this bleeding got bad, suspecting it may be some unsuspected interaction. Unfortunately, it continued to worsen. Still, I'll probably be very selective about which, if any, supplements I re-start, when and if I heal. Still waiting to hear from radiologist whether this IS a heal-able thing, or if it is a lifelong condition to manage, as endoscopist doc seemed to suggest with her recommendation for repeat procedures when needed.

[GrouseMan]

I see you are taking Aspirin and Celecoxib. I don't know how much but both of those can increase bleeding risks. Go easy on them....The best person to talk to about drug drug interactions is a Pharmacist not a doctor. Doctors get about a years worth of training about the use of drugs. Pharmacists spend much more than that - probably close to 4 years learning about drugs, and their interactions. Best person to speak too would be the main Pharmacist at a research Hospital! They continue to learn and do research which doctors don't have the time to spend on continuing drug education.

Regards,

GrouseMan

[Pita]

I have severe OA in my lower back and took Celebrex/Celecoxib for years until insurance forced me to use a generic, think I've been on it for 8-10 years. Every procedure that I have ever had I was told to stop taking the Celebrex/Celecoxib/generic at least 2 weeks prior as it can cause bleeding. Also was told not to take aspirin or Ibuprofen with Celebrex/Celecoxib/generic, only Acetaminophen (Tylenol) when needed. If I have any bleeding due to the Avastin I will stop using the generic Celebrex.

Best wishes to you and hope you can finish your treatment. ox

[Tupelo honey]

Thank you for everyone's replies. I currently am taking no supplements beyond my normal prescriptions. I do go to Simmons Cancer Center at UTSW in Dallas and the pharmacist at the hospital has been helpful several times.

As an update, I went to see my radiation doc last week after the diagnosis of radiation proctitis came back. He said it was unusual to see this with rectal cancer, due to the irradiated rectum usually being completely removed. I have a few centimeters of distal rectum left post LAR, that is what is swollen, inflamed and bleeding. He agreed that the twice daily sucralfate enemas are the appropriate first line treatment, second line treatments are hyperbaric oxygen treatments and third line is permanent ostomy (!) , but he feels I'll heal better once the chemo is over (and that if it was up to him, my chemo would be over now, but he would not second guess chemo doc). Per him, I connected this with Xeloda due to the mucositis caused by Xeloda. And the oxaliplatin is causing the bleeding to be more severe by lowering platelets, which were, at that time, 62. Severe bleeding causes the anemia I have. Vicious cycle!

Anyhow, I went for followup at the oncologist yesterday and they ok'd the last round of chemo based on on new labs measuring my platelets at 119, and RBC at 9, but left the choice to as to whether take it up to me. I'm going to go ahead and have the final chemo tomorrow and hope the darn (uncomfortable, inconvenient) enemas help keep the radiation proctitis in check. Like all y'all, I don't want to look back someday and wonder if I should have done more.

And, after that - I don't think they have a bell, but I'm done