Edema right after starting chemo?

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mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Edema right after starting chemo?

Postby mpbser » Fri Oct 13, 2017 8:09 am

Husband's face swelled a bit after his first Oxi infusion on Wednesday. This morning, it is really swollen, and his neck is a bit as well. His ankles are OK, as far as we can tell. Did anyone experience this? What did you do about it, if anything?

He's at his cardiologist's office right now. Hopefully everything is OK with his cardiovascular system.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

Aqx99
Posts: 403
Joined: Fri Mar 31, 2017 7:28 am
Facebook Username: aqx99
Location: Pfafftown, NC

Re: Edema right after starting chemo?

Postby Aqx99 » Fri Oct 13, 2017 3:24 pm

Did they give him steroids in his premeds? I always get a bit swollen and flushed after my infusions because of the steroids they give to combat nausea. It usually lasts about a week for me. Definitely check it out with the doctor though, just in case it is a reaction to the chemo.
Anne, 40
Stage IIIB Rectal Cancer
T3N1bM0
2/21/17 Dx, Age 39
2/21/17 CEA 0.9
3/23/17 - 5/2/17 Chemoradiation, 28 treatments
6/14/17 Robotic LAR w/temp loop ileostomy, ovaries & fallopian tubes removed, 2/21 lymph nodes positive
7/24/17 - 12/18/17 CapeOx, 6 Cycles
7/24/17 Dx w/ovarian cancer
9/6/17 CA 125 11.1
11/27/17 CEA 2.6
12/5/17 CT NED
12/13/17 CEA 2.9
1/11/18 CA 125 8.6
1/23/18 Reversal
3/21/18 CT enlarged thymus
4/6/18 PET NED
7/10/18 CT NED
7/11/18 CEA 2.6
9/18 Bilateral Prophylactic Mastectomy

cbsmith
Posts: 87
Joined: Sat Nov 28, 2015 11:45 am
Location: New Brunswick, Canada

Re: Edema right after starting chemo?

Postby cbsmith » Fri Oct 13, 2017 4:36 pm

I am always flush and a bit red after chemo from the steroids. It usually lasts for about 2-3 days and then goes away.
06/14-DX with FAP as 36yo Male
07/14-total colectomy, rectum removal, permanent ileostomy
08/14-DX Stage IIIC, KRAS mutant, MSS
09/14-04/15 - 12 rounds of FOLFOX
07/15-CT showed para-aortic lymph node, onc thght inflammation
10/15-DX Stage IV, CT lymph node tripled in size, 1 small lung met
11/15-FOLFIRI + Avastin
06/16-lymph node is stable, now have a 2nd lung met
01/16-lymph node is stable, lung mets grown 2mm. Still on FOLFIRI + Avastin
11/17 - no chemo since. Lung growth minimal, lymph node is stable

MissMolly
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Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Edema right after starting chemo?

Postby MissMolly » Fri Oct 13, 2017 8:24 pm

mpbser
You would be well advised to discuss with your hisband’s oncologist the dosage of dexamethasone (decadron) given to him as a pre-medication.

Dexamethasone is the most potent of the class of corticosteroids. 1 mg dexamethasone is equivalent to what the body produces naturally as cortisol in a given day. The typical pre-med dose administered is 4 mg of dexamethasone. It is a whopper of a dose.

Dexamethasone may affect your husband on more levels than other people. Corticosteroids have a direct affect on the pancreas, raising insulin levels and blood glucose levels. Management of your husband’s type 2 diabetes will be more challenging. Fluid retention and laying of added adipose tissue is a common effect of steroids. A rounded face (“Moon Face”), added adipose tissue around the waist and mid-section, and thickening of the upper back and scapula (“Buffalo Hump”) are specific areas where the visual effects of steroids are noteable. Steroids also cause transient suppression of the pituitary gland.
Adrenal gland failure (adrenal insufficiency) can occur with long-term steroid use or high dose steroid use over a shorter time interval.

I have adrenal insufficiency and often caution individuals receiving chemotherapy to query their oncologist regarding dexamethasone dosing. It is always advantageous to use the lowest steroid dose possible to arrive at the desired effect.

The role of dexamethasone is to quell nausea and inflammation of the intestinal tract due to chemotherapy and to uplift how a person feels systemically. Not all people need 4 mg dexamethasone per infusion to achieve those objectives. Some people are provided with additional oral dexamethasone to take at home for the first 2-3 days after an infusion. The point being: The amount of corticosteroid prescribed per round of chemotherapy can be substantial - with a delayed domino effect of unanticipated and medically troubling side effects.

Be an informed patient. Know the amount/dosing of corticosteroid that is being prescribed for you. Talk with your ordering oncologist. Work toward taking the lowest dosing of corticosteroid that keeps you comfortable during chemotherapy.
Karen
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Edema right after starting chemo?

Postby mpbser » Sat Oct 14, 2017 7:00 am

Thanks, everyone! Yes, he was given steroids. That can explain both the elevated BP and the facial swelling. He's looking much better and his BP is back to where it usually is, so it looks like the effect was thankfully only for a couple days.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

NHMike
Posts: 2555
Joined: Fri Jul 21, 2017 3:43 am

Re: Edema right after starting chemo?

Postby NHMike » Sun Oct 15, 2017 6:32 pm

Good to hear that he's doing well. Is he getting Oxi with 5FU or without it? I take it that you're doing everything locally now.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

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CRguy
Posts: 10473
Joined: Sun Feb 10, 2008 6:00 pm

Re: Edema right after starting chemo?

Postby CRguy » Sun Oct 15, 2017 11:05 pm

mpbser wrote:Thanks, everyone! Yes, he was given steroids. That can explain both the elevated BP and the facial swelling. He's looking much better and his BP is back to where it usually is, so it looks like the effect was thankfully only for a couple days.

Glad he's feeling better as well !
Another consideration / issue may be the infused volume and rate ... if too much is infused too rapidly, you will get a "volume overload" effect
and that will increase blood pressure and may contribute to localized edematous changes.
Just a couple of things to be discussed and considered for future infusions. The total volume will likely stay the same BUTT if it is infused more slowly ... it could help decrease the BP / swelling issues !

No doubt the dexamethasone contributes to this as well, so ask the Oncs about a possible dose decrease for this.
I eventually had minimal dex only on infusion day with no follow up and did just fine ( NO allergic / nausea reactions )
His Oncs should be able to assist and guide you with this, based on the specifics of his situation.

Best wishes
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

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LPL
Posts: 651
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Edema right after starting chemo?

Postby LPL » Wed Oct 18, 2017 2:13 pm

Mpbser,
Please see below in my signature what happens to my DH.
These steroids (as Miss Molly explained) can wreak havoc on some people. Hubby did his chemo NR 4-12 without steroids and he did not miss them!!! Steroids was like poison for him.
Good Luck with your DH’s following treatments.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung NED again Oct-19 :)
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb & Oct lung mets


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