Dexamethasone

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Pyro
Posts: 305
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Dexamethasone

Postby Pyro » Sun Apr 21, 2019 9:34 am

CRguy wrote:
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 ! :shock:

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


Thank you, I was just trying to understand it. My infusions days were usually my best days, due to the steroids, but there is a cost. Appetite? Medical marijuana, but at his age maybe edibles? I was told at a dispensary that the edibles won’t work if he doesn’t have a gall bladder, who knows if this is true, but letting you know. He will eat your pantry.
Aug 2015- Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail
Jun 2019 - FOLFURI
Aug 2019 - No more, quality time!

Caat55
Posts: 680
Joined: Sat Dec 23, 2017 6:01 pm

Re: Dexamethasone

Postby Caat55 » Sun Apr 21, 2019 6:21 pm

Chemo makes everything different. I could eat oatmeal, prosciutto, pickles. Sweets tasted awful. Try different foods, maybe something will be okay.
S
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018
PET NED 12/18
Clear Colonoscopy 2/19

natelaugh
Posts: 95
Joined: Wed Apr 03, 2019 11:40 pm

Re: Dexamethasone

Postby natelaugh » Sun Apr 21, 2019 10:29 pm

My dad tongue is white and he said something due to his stomach being cold. I guess it is some Chinese herb terminology. He is using Chinese herb to fix this issue. He has been doing Chinese med for over 40yrs. He is off chemo this week, I guess if he thinks the Chinese herb can help him eat, then I am ok with that. I told him it is side effect of chemo. He thinks it is because he drank protein premier.

As for medical cannabis, we have access to it. However, he is old school and doesn't trust it because of the THC high.

My neighbor has cancer in his blood I think stage iv. He stop chemo and used Entyvio and THC oil pills. He got his taste back after a month and gain alot of weight which he had lost during chemo. The last time I spoke to him he said his cancer stop spreading and got smaller.

Nate.
Caregiver to 80M
DX:CC,RC,desc
11/2018 rightPain
1/19/19 scopy,path
1/23 CTscan
2/19 surgery
2/26-2/28 NGTube
2/28-3/14 TPN bc ileus
3/2 2nd surgeryCloseOpenWound
3/4-3/28 woundVac
size: 6cm Adenocarcinoma
grade Poorly
Stage IIIC T3N2aMx
PositiveLymph:5of28
BaselineCEA:68
LVI:Y
PNI:N
Surgical margins:clear
MSI:MMR (MLH1, MSH2, MSH6, PMS2) Intact nuclear expression
Lynch status:N
Laparascopic, partial colectomy
CEA:3/28/19 2.8
Chemo:4/16/19-9/17/19 5FU,12cycles,every 14days,leucoverin,zofran,Dexamethasone

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Dexamethasone

Postby MissMolly » Mon Apr 22, 2019 9:10 am

Nate:
Dexamethasone is also known as Decadron.

Dexamethasone/Decadron is also used to reduce cerebral edema (ex. following a head injury). The “white tongue” that you see in your father may be from the effects of dexamethasone and drying of the oral mucosa.

Dexamethasone has a long half-life. The half-life of a dose of dexamethasone is about 40-50 hours. After two days, about 50% of a dose taken remains in the body. After four days, about 25% the dose remains in the body. After a week, about 10% remains in the body.

I have been on exogenous corticosteroids for 20 years. Continued use of corticosteroids does change the body, inside and out.

A rounded, puffy face is a common attribute (“Moon Face), as is fat distribution to the upper back/shoulder girdle and abdomen.
Effects to the muscles include muscle fiber atrophy and accompanied weakness. At one point, I looked like a little football with a rounded abdomen and stickly thin arms/legs. Osteoporosis is another concern with steroids and hip/wrist fracture risk. Blood glucose levels rise due to increased release of insulin (people tend to be hungry for sugary or salty snack foods when on corticosteroids).
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.

Pyro
Posts: 305
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Dexamethasone

Postby Pyro » Thu Apr 25, 2019 8:15 am

MissMolly wrote:Nate:
Dexamethasone is also known as Decadron.

Dexamethasone/Decadron is also used to reduce cerebral edema (ex. following a head injury). The “white tongue” that you see in your father may be from the effects of dexamethasone and drying of the oral mucosa.

Dexamethasone has a long half-life. The half-life of a dose of dexamethasone is about 40-50 hours. After two days, about 50% of a dose taken remains in the body. After four days, about 25% the dose remains in the body. After a week, about 10% remains in the body.

I have been on exogenous corticosteroids for 20 years. Continued use of corticosteroids does change the body, inside and out.

A rounded, puffy face is a common attribute (“Moon Face), as is fat distribution to the upper back/shoulder girdle and abdomen.
Effects to the muscles include muscle fiber atrophy and accompanied weakness. At one point, I looked like a little football with a rounded abdomen and stickly thin arms/legs. Osteoporosis is another concern with steroids and hip/wrist fracture risk. Blood glucose levels rise due to increased release of insulin (people tend to be hungry for sugary or salty snack foods when on corticosteroids).
Karen


I didn’t know a lot of that, and I’ve had a lot of Dex. I came on strong earlier because it helps me feel great on infusion day, it’s the best day of all of them while going through this crap. It really does help, however, the bone pain a few days later isn’t pleasant. I didn’t know that about the insulin, guess I shouldn’t do the weed along with the Dex, but it definitely helps me put on weight!
Aug 2015- Stage 4 CC with liver Mets(38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not liver surgery candidate
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda fail
Jun 2019 - FOLFURI
Aug 2019 - No more, quality time!

natelaugh
Posts: 95
Joined: Wed Apr 03, 2019 11:40 pm

Re: Dexamethasone

Postby natelaugh » Thu Apr 25, 2019 11:24 pm

Thank you Karen. I search for dexamethasone and found your post about it on the day of my dad first chemo cycle. We had an appointment today with the oncologist and he doesn't think the dexamethasone cause the white tongue. Usually I tend to trust more with people that have used it and did review on it. The oncologist will lower the dosage to 4mg for his next cycle and claim it is mainly for nausea. I don't understand why use 2 nausea med, zofran and dexamethasone. When I asked use only zofran, he said dexamethasone also help with anti inflammation.

Pyro, my dad also has bone pain. When I ask the oncologist about dexamethasone causing bone pain, he claims it is something else and nothing related to dexamethosone. Hopefully, lowering the dosage 4mg will help my dad with his bone pain.

BTW, I am happy to get any feed back and want to thank everyone for helping!!

Nate.
Caregiver to 80M
DX:CC,RC,desc
11/2018 rightPain
1/19/19 scopy,path
1/23 CTscan
2/19 surgery
2/26-2/28 NGTube
2/28-3/14 TPN bc ileus
3/2 2nd surgeryCloseOpenWound
3/4-3/28 woundVac
size: 6cm Adenocarcinoma
grade Poorly
Stage IIIC T3N2aMx
PositiveLymph:5of28
BaselineCEA:68
LVI:Y
PNI:N
Surgical margins:clear
MSI:MMR (MLH1, MSH2, MSH6, PMS2) Intact nuclear expression
Lynch status:N
Laparascopic, partial colectomy
CEA:3/28/19 2.8
Chemo:4/16/19-9/17/19 5FU,12cycles,every 14days,leucoverin,zofran,Dexamethasone

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Dexamethasone

Postby MissMolly » Fri Apr 26, 2019 12:17 am

Nate:
The inclusion of dexamethasone as a pre-medication provides more than nausea control/nausea relief.

Chemotherapy is a tough assault on the body. Dexamethasone has properties as a potent corticosteroid that provides benefits to lessen the experienced distress that accompanies chemotherapy. It has a strong anti-inflammatory effect, soothing to the intestinal lining that often suffers collateral damage. The cells of the intestinal mucosa are rapidly dividing cells. Cancer cells are also rapidly dividing cells. Chemotherapy affects both cells.

Dexamethasone makes almost everyone “feel better,” whether given as a chemo pre-med or to treat asthma or to treat ulcerative colitis or to treat rheumatoid arthritis. Dex is activating. Blood glucose levels are higher, so there is more energy available to the body. People will feel a boost.

Dexamethasone (as Decadron) is used to reduce intracranial and spinal pressure. Drying of the mouth and eyes/tears is a side effect. I wonder why the MD was so quick to dismiss the plausible role of dex in your father’s drier tongue. But it is not a major area of contention.

Bone pain can accompany high doses of dexamethasone where bone marrow becomes suppressed (lower white blood cell counts, lower macrophage counts, less robust immune response). This is a less common finding, and usually comes with long-term or high dose use of dexamethasone.

Your father is older (80 years of age). The side-effects of dexamethasone may affect him more strongly than a younger person.

I would NOT suggest that dexamethasone be excluded from anyone’s chemotherapy regimen. Corticosteroids have a beneficial role in easing the stress to the body that comes with the necessity of chemotherapy.

What I am suggesting is it is wise for each person to discuss the dosage of dexamethasone with his/her oncologist after the first 3-4 rounds of chemotherapy are completed. Too often it is dosed as a one-size-fits-all. Discuss the benefit/risk profile of dexamethasone specific to you to see if a lower doseage is warranted to reduce the potential for unwanted long-term effects.
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.

natelaugh
Posts: 95
Joined: Wed Apr 03, 2019 11:40 pm

Re: Dexamethasone

Postby natelaugh » Fri Apr 26, 2019 12:54 am

Karen,
I had a conversation with the oncologist. My thought is my dad doesn't have any nausea and we don't know if chemo might cause him nausea. I want to wait and see if my dad has nausea then give him the dexamethasone. My point is give Dex when nausea shows because it might not be needed and we might cause more harm than benefit. My oncologist said it's wise to give before nausea bc it works better to prevent and dexamethasone will not work once nausea occur. He also stated, if my dad has a bad experience with chemo it will cause a psychology effect when going to chemo will trigger nausea, anxiety. He keeps saying it's standard procedure, which I dislike bc everyone is different. So I said my dad is on one chemo, 5fu and not on oxaliplatin. He finally agreed to lower to 4mg.

I wanted to discuss with him and see what his reasons for such high dosage. If his argument is strong and unwilling to compromise then I know he believes what he doing is correct. However, he is willing to lower the dosage and stated that in the past he had lower other patient dosage.

I questions the oncologist on every meds that he gives to my dad. When he starts to give me data and statistics, and stand firm on the med and correct my limited knowledge that I have, then I have confident he is doing thing correctly.
Caregiver to 80M
DX:CC,RC,desc
11/2018 rightPain
1/19/19 scopy,path
1/23 CTscan
2/19 surgery
2/26-2/28 NGTube
2/28-3/14 TPN bc ileus
3/2 2nd surgeryCloseOpenWound
3/4-3/28 woundVac
size: 6cm Adenocarcinoma
grade Poorly
Stage IIIC T3N2aMx
PositiveLymph:5of28
BaselineCEA:68
LVI:Y
PNI:N
Surgical margins:clear
MSI:MMR (MLH1, MSH2, MSH6, PMS2) Intact nuclear expression
Lynch status:N
Laparascopic, partial colectomy
CEA:3/28/19 2.8
Chemo:4/16/19-9/17/19 5FU,12cycles,every 14days,leucoverin,zofran,Dexamethasone

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Dexamethasone

Postby MissMolly » Fri Apr 26, 2019 9:09 am

Nate:
I think the conversations that you have engaged with your father’s oncologists will prove to be helpful in establishing a collaborative relationship in future discussions, as well.

The body produces the equivalent of 0.8 mg dexamethasone as naturally occurring cortisol a day. Cortisol is a life-essential hormone.

The initial dose for 12 mg dexamethasone prescribed is a whopper. A large 12 mg dose is compounded by dex’s long half-life (40-50 hours) - that is, it takes 40-50 hours to metabolically clear 1/2 of the dose administered. Dexamethasone acts on the body for an extended period of time. Dexamethasone is the most potent of the class of glucocorticostroids (which includes hydrocortisone, prednisone, cortisone, et al).

Downshifting to a 4 mg dosage of dexamethasone seems prudent.

A 4 mg dose of dexamethasone sounds more reasonable for your father’s situation as you have shared (5 FU without oxi; elderly 80 years of age) where the benefits of dexamethasone can be leveraged while minimizing adverse effects which, themselves, can be life-altering.

You are to be commended for partnering with your father’s oncologist to better define a mindful and thoughtful approach. It is not so easy to do.

I hope your father does well with his next infusion and that it is well tolerated,
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.

natelaugh
Posts: 95
Joined: Wed Apr 03, 2019 11:40 pm

Re: Dexamethasone

Postby natelaugh » Mon May 27, 2019 5:03 pm

MissMolly wrote:Nate:
I think the conversations that you have engaged with your father’s oncologists will prove to be helpful in establishing a collaborative relationship in future discussions, as well.

The body produces the equivalent of 0.8 mg dexamethasone as naturally occurring cortisol a day. Cortisol is a life-essential hormone.

The initial dose for 12 mg dexamethasone prescribed is a whopper. A large 12 mg dose is compounded by dex’s long half-life (40-50 hours) - that is, it takes 40-50 hours to metabolically clear 1/2 of the dose administered. Dexamethasone acts on the body for an extended period of time. Dexamethasone is the most potent of the class of glucocorticostroids (which includes hydrocortisone, prednisone, cortisone, et al).

Downshifting to a 4 mg dosage of dexamethasone seems prudent.

A 4 mg dose of dexamethasone sounds more reasonable for your father’s situation as you have shared (5 FU without oxi; elderly 80 years of age) where the benefits of dexamethasone can be leveraged while minimizing adverse effects which, themselves, can be life-altering.

You are to be commended for partnering with your father’s oncologist to better define a mindful and thoughtful approach. It is not so easy to do.

I hope your father does well with his next infusion and that it is well tolerated,
Karen


Thank you Karen!!!

Nate.
Caregiver to 80M
DX:CC,RC,desc
11/2018 rightPain
1/19/19 scopy,path
1/23 CTscan
2/19 surgery
2/26-2/28 NGTube
2/28-3/14 TPN bc ileus
3/2 2nd surgeryCloseOpenWound
3/4-3/28 woundVac
size: 6cm Adenocarcinoma
grade Poorly
Stage IIIC T3N2aMx
PositiveLymph:5of28
BaselineCEA:68
LVI:Y
PNI:N
Surgical margins:clear
MSI:MMR (MLH1, MSH2, MSH6, PMS2) Intact nuclear expression
Lynch status:N
Laparascopic, partial colectomy
CEA:3/28/19 2.8
Chemo:4/16/19-9/17/19 5FU,12cycles,every 14days,leucoverin,zofran,Dexamethasone


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