The Colon Club

Hi.
My dad started chemo today. They gave him Dexamethasone 12mg pre med for 5fu. They say it's for nausea. They also gave zofran which is also nausea. Do you need dexamethasone?

Nate

They gave it to me as well. I can't say whether it hurt or helped initially but chemo nurses talked me into continuing. Read posts about avoiding folic acid supplements. I am convinced that protected me from some of the long term neurological symptoms others describe.
S

Nate -

Would you be able to take the time to create a signature? I think it would help in eliciting informed replies to your posts.
Thank you.

..
If you are looking for support that would be specific to your situation, I think it would help if you could create a Signature to show the basics of the diagnosis, staging, and treatment regimen, as well as a sort of brief history of all of the tests, procedures, etc. that have been done so far and those that are yet to come. This is so that persons who read your current post (and any of your future posts) can determine whether or not they have anything relevant to say -- and they do this by comparing their own situation with what you have put in your signature and in your posts.

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Remember, the best kind of feedback usually comes from people who are in the same situation as you. Readers won't know if they are in the same situation as you, however, unless you put your details in your signature.

A link for creating your signature is given below. It doesn't take long to set up a signature, then you will have a short summary of your situation that can be displayed at the bottom of all your future posts whenever you choose the "Attach a signature" option. (You can always go back later to update your signature in case the need arises.)

Here's the direct link for creating your signature (512 characters maximum):
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I know that Dexamethasone is given to my husband with HAI pump chemo to protect the liver from biliary stenosis. It reduces the incidence by greater than half, if I recall correctly. I know the % is significant according to the studies. In that case, I would consider it "necessary."

I am fairly certain that it is given with systemic chemo as well for similar protective purposes. I don't know what they are at the moment. Perhaps someone else can chime in.

I know that I received a steroid as a premed with folfox. I can't recall the precise name, but it was called "dexie." I discussed the possibility of discontinuing it with my oncologist, since it destroyed my blood sugar control, but he said the major purpose was to avoid infusion reaction to the chemo drugs, oxy in particular, so it would be unwise to do so.

Of course, it has other effects also.

I have posted about dexamethasone before and will do so again, as a “public safety announcement” of sorts.

I am not a cancer patient. I am an individual with adrenal failure (Addison’s disease) and know well the unfortunate consequences that glucocorticosteroid use can ravage on the body.

Dexamethasone is a glucocorticosteoid. It is the more potent of the other members of this class of medications (prednisone, hydrocortisone, prednisolone).

The body naturally produces cortisol, a life essential corticosteroid. Cortisol is secreted by the adrenal glands, who sit atop each pole of the kidneys. There is a diurnal pattern to the secretion of cortisol, part of the body’s circadian rhythm that influences sleep/wake and digestive functions. Cortisol secretion is regulated by an intricate negative feedback loop with the Pituitary gland.

Cortisol is a life-essential hormone. Cortisol is required at an intracellular level by every cell in the body. Every cell. The effects of cortisol affect every cell and every body system. Cortisol is also pivotal in the regulating stress and the fight-flight response.

The body produces about 20 mg of cortisol a day. This is the equivalent of about 1 mg of dexamethasone.

A 12 mg dose of dexamethasone as a chemotherapy premed is a substantial dose of steroid.

Here lies the potential problem . . . .

Exogenous dosing of dexamethasone (or any glucorticosteroid) has the effect of suppressing the Pituitary gland and HPA axis (hypothalamus-Pituitary-adrenal) when external dosing of steroid exceeds the body’s basal requirement. Long-term and/or high dose use of corticosteroids is the concern. A suppressed HPA axis is sometimes not able to “re-boot” when external/exogenous dosing is withdrawn. The HPA axis is impaired functionally.
The result is cortisol deficiency termed “secondary adrenal insufficiency.”

The effects of secondary adrenal insufficiency are truly life-impacting and serious. This is not a condition that anyone would wish for their worst enemies. Symptoms: Profound fatigue, not relieved by rest; severe muscle and joint pain, full body pain; nausea, vomiting, low appetite, GI distress; cognitive “fog” with difficulties with concentration, thinking, and memory; low blood pressure, especially with postural changes such as sit to stand; altered serum electrolytes, low potassium and sodium; weakness; malaise; sensitivity to lights, sounds.

Dexamethasone is given as a pre-medication during chemotherapy to soften the distressing body effects of chemotherapy, reduce nausea, and provide powerful anti-inflammatory effects. Dexamethasone will also provide an uplifting and energizing effect. You will have a boost in energy and generally “feel better” with a dose of steroid. Steroids influence added release of insulin by the pancreas, elevating blood glucose levels.

Dexamethasone has benefits as an IV chemotherapy additive.

But it is important to weight the risk/benefit for each person in conversation with their oncologist. Too often, a standard one-size/fits-all dose of dexamethasone is prescribed without consideration of a person’s body mass, weight, or risk for endocrine disruption.

A lower dose of dexamethasone can be sufficient for the purposes desired. I encourage every chemotherapy patient to have a 1:1 discussion with his/her oncologist to discuss dexamethasone dosage. What is the ideal dosage for me?

Above all, be aware of secondary adrenal insufficiency. Educate yourself as to its symptoms and manifestation. Adrenal insufficiency is not a condition that is readily recognized by physicians. Mis-diagnosis and inaccurate diagosis prevail, leaving individuals to suffer and to be dismissed by health care professionals.
Karen

O Stoma Mia wrote:Nate -

Would you be able to take the time to create a signature? I think it would help in eliciting informed replies to your posts.
Thank you.

Done, thanks for the suggestion.

When my mom had chemo, she took this right before the infusion and then was instructed to take a dose for two days following. They also wrote two additional prescriptions for nausea if she needed them (zofran was one and the other one started with a c) but she never needed either.

natelaugh wrote:Hi.
My dad started chemo today. They gave him Dexamethasone 12mg pre med for 5fu. They say it's for nausea. They also gave zofran which is also nausea. Do you need dexamethasone?
Nate

Dex has a a nonspecific anti-emetic effect, given pro-actively with many chemos
(= they don't know exactly HOW it prevents nausea ... it just does ! )
ALSO Dex is a potent corticosteroid which has a major role in pro-actively helping to prevent allergic reactions to various chemos.

Do You NEED DEX ????
IMO = probably a good idea for the first few rounds to DO WHAT THE DOCS SAY !!!!!!!
I did ... then WITH DOC'S permission, I asked for a decrease Dex dose with each chemo
and I eventually ended up with only 2 mg prior to Oxaliplatin infusions.
I never had any Dex with Xeloda or just 5FU infusions.
BUTT ...
I never had major issues with either Xeloda or 5FU ... so ... wondering why the heavy Dex for that ??????
ALSO ... the other anti-emetics are great : I never really needed them BUTT if you have Zofran and some Dex on board
... that should be a good combo.

Does he need 12 mg DEX ??????
Have that conversation with the docs after the first round.

Doctor mindset = " I would rather PREVENT bad side effects for my patients ... THAN making THEM have to deal with it later. "
Patient mindset = " I want what I NEED ... BUTT if it ain't working for ME ... we need a new plan ! "

Best wishes and post / PM me anytime

CRguy on the Journey

CRguy wrote:
Does he need 12 mg DEX ??????
Have that conversation with the docs after the first round.

Doctor mindset = " I would rather PREVENT bad side effects for my patients ... THAN making THEM have to deal with it later. "
Patient mindset = " I want what I NEED ... BUTT if it ain't working for ME ... we need a new plan ! "

Best wishes and post / PM me anytime

CRguy on the Journey

I ask the nurse many times does he need it and she replied it is standard procedure and they give it to everyone doing chemo there. She said dexamethasone was for preventing nausea. I did a quick Google and it also said med was for anti-inflammation. With limited knowledge and uncertainty I went along with the nurse.

My dad has no side effect from 5FU beside swollen feet, but this might not be related to 5FU. I will ask a lower dosage of 3mg dexamethasone.

On average, how many chemo cycles to notice any side effects?

Nate.

Everyone is so different in terms to how they react to chemo so there is really no “average”. Since he isn’t doing Ox, he won’t have to worry about those side effects. My mom started feeling tired around round 6 and her hair started thinning after completing 8 rounds.

natelaugh wrote:

CRguy wrote:
Does he need 12 mg DEX ??????
Have that conversation with the docs after the first round.

Doctor mindset = " I would rather PREVENT bad side effects for my patients ... THAN making THEM have to deal with it later. "
Patient mindset = " I want what I NEED ... BUTT if it ain't working for ME ... we need a new plan ! "

Best wishes and post / PM me anytime

CRguy on the Journey

I will ask a lower dosage of 3mg dexamethasone

.

Are you a doctor or basing this off google searches? These are scientifically researched cocktails and put together with good reason. Oxy is no joke, probably the worst I’ve been on, and you want to limit something that could help him? If anything it will stimulate his appetite, which is going to be non existent on oxy.

Pyro wrote:Are you a doctor or basing this off google searches?

Vet and long term survivor, respectfully, read my bio for the full deal !

patients need to be able to have discussions with their own docs to see what works in their individual situation.
FYI ... basically ALL textbook protocols are modifiable within the context of doctor patient relationship, hence my actual comment to

Have that conversation with the docs after the first round.

The patient in question appears to be getting dex for 5FU only, not oxy,
so you are invited to re-read the OP and my comments in their entirety

CRguy

Pyro wrote:

natelaugh wrote:

CRguy wrote:
Does he need 12 mg DEX ??????
Have that conversation with the docs after the first round.

Doctor mindset = " I would rather PREVENT bad side effects for my patients ... THAN making THEM have to deal with it later. "
Patient mindset = " I want what I NEED ... BUTT if it ain't working for ME ... we need a new plan ! "

Best wishes and post / PM me anytime

CRguy on the Journey

I will ask a lower dosage of 3mg dexamethasone

.

Are you a doctor or basing this off google searches? These are scientifically researched cocktails and put together with good reason. Oxy is no joke, probably the worst I’ve been on, and you want to limit something that could help him? If anything it will stimulate his appetite, which is going to be non existent on oxy.

I'll talk with my dad oncologist next week about dexamethasone. After 2 days off from his first cycle, he doesn't have taste and not eating much. He is only on 5fu and the 12 mg dexamethasone is standard protocol.

Any suggestions on things we can do to help with his taste and appetite?

Thanks,
Nate.

The taste problem is difficult to deal with I even had trouble drinking water, one thing I found that helped was peppermint candy, the round red and white striped ones. I would have one in my mouth while drinking, worked really good. As far as eating, anything he has an appetite for,. feed it to him! Don't worry about sticking to a healthy diet while on chemo unless it works for him. And drink a bottle of boost, ensure or similar nutrient supplements with every meal.

Dan