Infection and markers

[rp1954]

Actually she has no any neuropathy symptoms, and overall she doesn't feel bad. May be due to IV vit C + a lot of supplements.
It was 9th Folfox cycle. After the 8th, the markers began to grow, onc ordered CT and continued folfox.

Glutamine may be a substantial factor to reduce oxi- related neuropathies. A number of papers on search engines.

[IM64]

Realities

Thanks a lot rp1954. This is a very complete answer. Maybe not quite good for us but complete and honest.

Some things we are not able to change (or change quickly) - tumor load and right doctor(s). The second is more important, because the right oncologist could suggest/advice/help how to reduce that tumor load. And you are absolutely right - our std oncologist is not ready for any actions outside of the standard protocol. And he will never be ready, because he doesn't want it, and doesn't need it.

The second (technical) part is more comfortable for me. We have already organized all IVs at home. Some drugs (like C, ALA, Mistletoe, PSK, Fucoidan etc) I buy directly from Germany, Japan, China etc. We already have prescription for some off-label drugs (like Cimetidine, Celecoxib, Metformin, Naltrexone). Lot of already done.

My main concern is actually side effects after heavy chemo that could reach a level where oncologist have to stop ANY chemo. Every new folfox cycle gives a worse CBC result, plus GI bleeding from time to time. When the markers dropped, we were ready to switch to Xeloda. But now we are confused - really afraid to switch to more mild therapy during growing markers. But this is a fundamental question, because this possibility may be closed in future.

Anyway, I am very grateful that you raised all these questions. Your advice is very valuable to me. Thanks

[beach sunrise]

The at home IV therapy should help. It takes a minute to get things in order (finding the help you know you need) but its out there and you found it. Way to go!
Moss Report is online now and has some free info.

[IM64]

Moss Report is online now and has some free info.

Perfect! Your info is essential as always. Thanks
Just subscribed. Looks like there are a lot of what I need to know.

[beach sunrise]

I've been researching Protectival for WBC and RBC's. I think I will try it. I've tried everything else without results. Radiation damage is what it is. Found out about Protectival it in Moss Reports. It's a combo of herbs.
I subscribed so anything you want to research on there I will.

[IM64]

Thank you for your kindly offer, I subscribed too. Started reading and found that is a Klondike of information, especially for beginners like me.

[rp1954]

...you are absolutely right - our std oncologist is not ready for any actions outside of the standard protocol. And he will never be ready, because he doesn't want it, and doesn't need it.

In the US, they would lose money on ADAPT except for the crappier Medicaid states.

My main concern is actually side effects after heavy chemo that could reach a level where oncologist have to stop ANY chemo. Every new folfox cycle gives a worse CBC result, plus GI bleeding from time to time. When the markers dropped, we were ready to switch to Xeloda. But now we are confused - really afraid to switch to more mild therapy during growing markers. But this is a fundamental question, because this possibility may be closed in future.

Can you make a simple table of CBC, inflammation, liver panels, markers vs date, figure 11-12 date columns. No units unless at bottom, wobbly columns with unaligned 2-4 place decimal numbers fine (xxxx or xxx to 0.xxx), % or absolute WBC profile fractions fine. I'm thinking cut n paste of an image of your simplest spreadsheet might be faster and easier here.
Panel. [dx date eg 10/xx]. [date2] -->

RBC
Plate
WBC
Neut
Lymp
etc

[IM64]

Can you make a simple table of CBC, inflammation, liver panels, markers vs date, figure 11-12 date columns. No units unless at bottom, wobbly columns with unaligned 2-4 place decimal numbers fine (xxxx or xxx to 0.xxx), % or absolute WBC profile fractions fine. I'm thinking cut n paste of an image of your simplest spreadsheet might be faster and easier here.

Not sure I understand you completely, sorry. I keep all available blood tests data in excel file with graphs. Below are some of them. Green lines are low and high references, Red - test result. Under the graph are date of the tests and numerical test values. Hope that is what you asked.

[rp1954]

Thanks. That's a good start.
MIA on CBC: monocytes, basophiles, rdw, MCV,.
Panels: LDH, GGTP, total protein, albumin, PT/INR, bilirubin, AST
Inflammation: ESR, ferritin, ceruloplsmin
Markers. CA19-9, AFP

Are the early CEA really missing or just over range for the graph?
What's the timeline on your wife's flu symptoms resolving in February or not done?

[IM64]

Thanks. That's a good start.
MIA on CBC: monocytes, basophiles, rdw, MCV,.
Panels: LDH, GGTP, total protein, albumin, PT/INR, bilirubin, AST
Inflammation: ESR, ferritin, ceruloplsmin
Markers. CA19-9, AFP

Are the early CEA really missing or just over range for the graph?
What's the timeline on your wife's flu symptoms resolving?

I have all CEA data, but first numbers are too high for that graph (08-Oct - 3627, 10-Oct - 4163, 04-Nov - 2600, 02-Dec - 1472, 30-Dec - 703).

Last flu infection was approximately from mid to the end of February. She also got blood infection (sepsis) and spend a week in hospital in the second part of November.

I added more tests as you asked. Unfortunately, we started our own extended tests only from the end of January, so not all data available. Standard tests from oncologist are very limited. And we never ordered Total protein, AST, AFP.

[beach sunrise]

What does your ND say about RBC's, liver and inflammation markers?

[IM64]

He says nothing. We don't have ND who can treat cancer or advise something about it. All ND we contacted just work how IV clinic, massage, acupuncture etc. That is not US, we even don't have integrative doctors here in Canada. I prepare all protocols for supplements, IVC, ALA/LDN, etc. ND just checks and confirms them. Our benefit of him is a requisition to advanced blood tests which I needed, plus some help with off-label drugs.

[rp1954]

I am looking at your blood data.

I need a few more questions and data. I am going start with some observations and comparisons.

Your wife's CRP has declined from Jan to Feb 28. This could be a combined effect of the chemo and IV vitamin C.
Likewise her LDH is hovering in the 200s up to 300 now and could be a combined effect of chemo and IVC. The 2nd half of February data, LDH around UL might be flu, set it aside for the moment.
Ideally LDH is below 170 for mCRC patients with previously elevated LDH, a potential curative sign.
mCRC with elevated LDH and HIF-1a, due to anaerobic sugar metabolism elevates LDH into the 200s and beyond, like with your wife's early data
Since we missed over a year of LDH data, we don't have the high early LDH data but she had other signs of being an anaerobic sugar burner. By the time we started measuring LDH, long after surgery #2, with CEA and CA199 rises well below their prior peaks, a bad day for her LDH was at the UL (~265, a lot of lab variation on UL) and I would torque immuno chemo and IVC to drive LDH towards 200 or below. After 8 years chemo and IVC, we got LDH down to 170.

One natural question is what is your wife's optimum IV vitamin C, where C is known to accumulate in KRAS cancer cells and disrupt KRAS and HIF-1a metabolism. With my wife's small cancer tissue chunks in suspension, 5FU+C+K2 beat 5FU+oxi and/or iri, to the great dismay of the lab. To infuse more C there has to enough kidney and liver function, somewhat healthy livers and kidney can handle lots of vitamin C, well out beyond the upper optimum tx dose for prolonged tolerance of 90 grams/m2 in the literature (e.g. over 300 gram/m2/day?). 90g/m2 is roughly 40-50% higher than the 1.5 grams/kg UL dose usually used by oncology NDs. My impatient wife mostly used 1.25 max declining to 0.75 grams/kg after getting rising marker problems at ~0.4 grams/kg at much lower tumor burden.
So what does your wife's kidney data series look like?

AST (aka SGOT) is so common in liver panels (AST+ALT+ALP) of std and cheapo blood chemistry packages, I'm amazed if it's not in your drs data. A caregiver reference item if they don't start it.

I'd get at least one AFP for reference. It a cheap old marker.
Reticulocytes, "Retics" are immature RBC. They were added when the RBC got low.
Albumin is the most important protein lab, but I'd ask the onc for better cover with Total Protein A/G.
Also I'd get d-dimer and cortisol. NDs are usually all over the hormone panel.

Finally, what are the Folfox dose changes and change dates?
Any WBC or RBC colony stimulation factors yet?
In late January it looks dose reduction and/or some Neupogen/Neulasta.

[IM64]

I need a few more questions and data. I am going start with some observations and comparisons.

I would be happy to to answer all your questions and provide data if I have it. Your help and advice is highly appreciated.

Likewise her LDH is hovering in the 200s up to 300 now and could be a combined effect of chemo and IVC. The 2nd half of February data, LDH around UL might be flu, set it aside for the moment.
Ideally LDH is below 170 for mCRC patients with previously elevated LDH, a potential curative sign.
mCRC with elevated LDH and HIF-1a, due to anaerobic sugar metabolism elevates LDH into the 200s and beyond, like with your wife's early data

I have a couple more LDH results from the end of 2022: 0ct.19 - 1897, Oct.24 - 1002, Nov.04 - 556, Dec.02 - 446

One natural question is what is your wife's optimum IV vitamin C, where C is known to accumulate in KRAS cancer cells and disrupt KRAS and HIF-1a metabolism.

That is a good question. Riordan IVC Protocol Research (https://riordanclinic.org/research-stud ... -protocol/) says "therapeutic goal of reaching a peak-plasma concentration of ~20 mM (350- 400 mg/dL) is most efficacious".
After 50g vit C (1.1g/kg), her level is 16-18. After 75g (1.35g/kg) - 22-24. Freshly compounded C gives 10-20% higher respond.
Her usual IVC protocol is 3 times per week - 2x 75g and 1x 50g. Also Riordan says "No increased toxicity for post-IVC plasma vitamin C levels up to 780 mg/dL has been observed" - it is about 40-42 mM, so we have enough room to increase.

With my wife's small cancer tissue chunks in suspension, 5FU+C+K2 beat 5FU+oxi and/or iri, to the great dismay of the lab.

What is the name of this test and where it can be done? This seems to be a very important test for treatment strategy.

90g/m2 is roughly 40-50% higher than the 1.5 grams/kg UL dose usually used by oncology NDs.

Her Body Surface Area is 1.6 - 1.67 based on different formulas, so 90g/m2 is 144 - 150g. Pretty high dose.

So what does your wife's kidney data series look like?

Unfortunately we didn't GFR test. I only have Creatinine and BUN for kidneys

AST (aka SGOT) is so common in liver panels (AST+ALT+ALP) of std and cheapo blood chemistry packages, I'm amazed if it's not in your drs data. A caregiver reference item if they don't start it.

I missed it. I ask third party doctor for requisition for extended tests I'd like to order, and no one check them except me. For our onc standard blood work is enough. I get much more info here from that forum than from him.

I'd get at least one AFP for reference. It a cheap old marker.
Reticulocytes, "Retics" are immature RBC. They were added when the RBC got low.
Albumin is the most important protein lab, but I'd ask the onc for better cover with Total Protein A/G.
Also I'd get d-dimer and cortisol.

Thanks, will ask to add.
I did D-dimer a couple last tests - it's too high (Feb.14 - 1931, Feb.28 - 1500). UL is 500.

Finally, what are the Folfox dose changes and change dates?
Any WBC or RBC colony stimulation factors yet?
In late January it looks dose reduction and/or some Neupogen/Neulasta.

No, nothing extra.
ND started low dose IM testosterone (250 mg/weekly) last week try to boost Hgb. That is off-label of course.

[rp1954]

[rp1954]Likewise her LDH is hovering in the 200s up to 300 now and could be a combined effect of chemo and IVC. The 2nd half of February data, LDH around UL might be flu, set it aside for the moment.
Ideally LDH is below 170 for mCRC patients with previously elevated LDH, a potential curative sign.
mCRC with elevated LDH and HIF-1a, due to anaerobic sugar metabolism elevates LDH into the 200s and beyond, like with your wife's early data
[IM64] 0ct.19 - 1897, Oct.24 - 1002, Nov.04 - 556, Dec.02 - 446
[rp1954"]One natural question is what is your wife's optimum IV vitamin C, where C is known to accumulate in KRAS cancer cells and disrupt KRAS and HIF-1a metabolism.
[IM64]That is a good question. Riordan IVC Protocol Research (https://riordanclinic.org/research-stud ... -protocol/) says "therapeutic goal of reaching a peak-plasma concentration of ~20 mM (350- 400 mg/dL) is most efficacious".
After 50g vit C (1.1g/kg), her level is 16-18. After 75g (1.35g/kg) - 22-24. Freshly compounded C gives 10-20% higher respond.
Her usual IVC protocol is 3 times per week - 2x 75g and 1x 50g. Also Riordan says "No increased toxicity for post-IVC plasma vitamin C levels up to 780 mg/dL has been observed" - it is about 40-42 mM, so we have enough room to increase.

Riordan Clinic is cautious and hasn't gone far enough to knock out CRC cells with vitamin C combinations in vivo. Our data matrix went up to 5FU+C+K2 in a background of at least targeted CIM and other residues.

Why the 50 gram C dose vs 75g C?
What is her IV vit C timing with relation to Folfox/Folfiri infusions (and 46 hr 5FU)?

FYI, "fresh C" (unoxidized ascorbate) is important for poisons and toxins, viral and bacterial infections, and maybe for a particular measurement but are there huge gaps about some of the most interesting data around vitamin C metabolites for cancer.

With my wife's small cancer tissue chunks in suspension, 5FU+C+K2 beat 5FU+oxi and/or iri, to the great dismay of the lab.

What is the name of this test and where it can be done? This seems to be a very important test for treatment strategy.

Chemosensitivity testing but it is hard to get done with (mega)vitamins added.
The labs are more interested to cater to their medical critics and perhaps mfrs of high cost drugs off label.

90g /m2 is roughly 40-50% higher than the 1.5 grams/kg UL dose usually used by oncology NDs.

Her Body Surface Area is 1.6 - 1.67 based on different formulas, so 90g/m2 is 144 - 150g. Pretty high dose.

Yes, 1.5 grams C/kg is the usual speed bump that most people stop at for an infusion. The only time I personally have seen that exceeded was 4 grams C/kg (in 22 hr) for breaking a severe COVID fever and hypoxia relatively fast when the local hospitals were already overfilled with Delta variant. The basic cautions are cation balances (Ca,Mg,Na,K), blood sugar levels, speed limits, a functional kidney and osmolarity.

The highest achievable blood concentration is going to be based on rate and total dose.

What infusion rates, times, or ranges does your wife get her IV vit C infused?
When does your wife get her bloodwork get drawn relative to the end of IV vitamin C?

So what does your wife's kidney data series look like?

Unfortunately we didn't GFR test. I only have Creatinine and BUN for kidneys

Estimated GFR based on a calculation from creatinine is the GFR everyone is slinging around. Measured GFR is annoying and relatively rare for outpatients.