Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

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CancerWarrior_23
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Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby CancerWarrior_23 » Sat Apr 01, 2023 11:17 pm

HI Everyone,

I am writing to seek your valuable advice and insights regarding my brother's current medical situation. We live outside of the United States and have some doubts about the medical staff at the hospital where he is receiving treatment. This is why we are reaching out to you for help.

My brother is a 36-year-old male diagnosed with metastatic colon cancer. He has recently completed the first cycle of his chemotherapy treatment, which consists of FOLFOX and bevacizumab. Along with this treatment, he has been prescribed the following medications:

Megamox 625 (Amoxicillin and Clavulanic Acid) - 3 tablets daily
Zoron 8 mg (Zofran / Ondansetron) - 2 tablets daily
Nexium 20 mg (Esomeprazole) - 2 tablets daily
Premosan 10 mg (Metoclopramide) - 2 tablets daily
Laxal (Sennosides) 12 mg - 2 tablets daily


Despite taking these medications, my brother has been experiencing strong stomach pain, particularly after eating. It is important to note that he took four tablets of Dexamethasone 0.5 mg before the first cycle of chemotherapy., which seemed to alleviate the stomach pain. But, he is currently not taking Dexamethasone.

I would greatly appreciate any advice, suggestions, or questions you may have to help my brother better understand his situation and potentially find relief from this stomach pain. If there are any additional details you think would be helpful to know, please do not hesitate to ask.

Thank you in advance for your time, expertise, and understanding.
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.

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beach sunrise
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Re: Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby beach sunrise » Sun Apr 02, 2023 6:22 pm

A signature would be a great idea for more help.
Is he sure its his stomach?
Off the top of my head, Aloe vera is good for coating the stomach, Turkey Tail for gut biome and immune system, NAC is a precurser for glutathione.
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

CancerWarrior_23
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Re: Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby CancerWarrior_23 » Wed Apr 05, 2023 10:01 am

beach sunrise wrote:A signature would be a great idea for more help.
Is he sure its his stomach?
Off the top of my head, Aloe vera is good for coating the stomach, Turkey Tail for gut biome and immune system, NAC is a precurser for glutathione.



Thank you for the suggestions and for asking about the stomach issue. we will definitely consider adding more information to my signature for better help. As for the stomach pain, we will consult my doctor to confirm the cause. I appreciate the recommendations for Aloe vera, Turkey Tail, and NAC.we will look into these options and discuss them with my healthcare team. Thanks again for your advice and support!
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.

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Jacques
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Re: Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby Jacques » Wed Apr 05, 2023 5:25 pm

beach sunrise wrote:A signature would be a great idea for more help...

...

BUMP - Still no signature. Still not enough information about the patient to make any kind of assessment or to do a proper "situation analysis". In the information previously given there are already several "red flag" issues that need to be resolved, but more information is needed in order to do this.

Questions

1. What kind of doctor prescribed these five medications? When did the prescription for these five medications start? Did the doctor explain what each of these five medications was for? Did the doctor explain how/when to take the medications? Did he explain the restrictions to be followed when taking the medications? Which of these meds are to be taken twice a day, every day, no matter what (BID), and which (if any) are to be taken only if and when they are needed (PRN)?

2. Did the doctor explain why an antibiotic was prescribed and how many days it would have to be taken? Did the doctor explain what kind of infection it was that required this particular antibiotic?

3. How long will these particular prescriptions last? What will be the plan when the next chemo cycle starts? Same prescriptions?  Different prescriptions?

4. Did the patient report the abdominal cramps immediately to the doctor as required by the protocol? What did the patient do to cope with the abdominal pain, and was this done with the approval of the doctor?  Note: Some pain meds are contraindicated for persons who have  compromised livers.

5. Did patient have any instruction on the types of food to prefer ; types of food to avoid? What kind of diet was the patient following when he experienced the abdominal pain? Were any special dietary restrictions imposed by the  doctor when  the medications were first prescribed?

CancerWarrior_23
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Re: Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby CancerWarrior_23 » Sat Apr 08, 2023 8:11 pm

Jacques wrote:
beach sunrise wrote:A signature would be a great idea for more help...

...

BUMP - Still no signature. Still not enough information about the patient to make any kind of assessment or to do a proper "situation analysis". In the information previously given there are already several "red flag" issues that need to be resolved, but more information is needed in order to do this.

Questions

1. What kind of doctor prescribed these five medications? When did the prescription for these five medications start? Did the doctor explain what each of these five medications was for? Did the doctor explain how/when to take the medications? Did he explain the restrictions to be followed when taking the medications? Which of these meds are to be taken twice a day, every day, no matter what (BID), and which (if any) are to be taken only if and when they are needed (PRN)?

2. Did the doctor explain why an antibiotic was prescribed and how many days it would have to be taken? Did the doctor explain what kind of infection it was that required this particular antibiotic?

3. How long will these particular prescriptions last? What will be the plan when the next chemo cycle starts? Same prescriptions?  Different prescriptions?

4. Did the patient report the abdominal cramps immediately to the doctor as required by the protocol? What did the patient do to cope with the abdominal pain, and was this done with the approval of the doctor?  Note: Some pain meds are contraindicated for persons who have  compromised livers.

5. Did patient have any instruction on the types of food to prefer ; types of food to avoid? What kind of diet was the patient following when he experienced the abdominal pain? Were any special dietary restrictions imposed by the  doctor when  the medications were first prescribed?



Dear Jacques,

Thank you for your help and input. We are new to dealing with cancer and may not know everything we should. Please accept our apologies for any misunderstandings.

I would like to inform you that the patient had a blood test on 04-04-2023 after the first chemo cycle with a 20% dose reduction and Avastin (bevacizumab) on 28-03-2023. The next chemo session will be on April 11th. The abdominal pain experienced on April 6th has resolved.

I have updated my signature with the patient's case information. If you have any tips or thoughts about it, we would appreciate your advice.

Additionally, here's a summary of the blood test results after the first chemo cycle:

CBC showed increased WBC and reduced Hemoglobin, Hematocrit, MCV, MCH, MCHC, and RDW, with an elevated Platelet count.
Coagulation Profile indicated prolonged PT, PTT, and slightly increased INR.
Differential White Blood Cell Count showed decreased Lymphocytes.
Liver Function Tests revealed normal ALT and AST levels, but elevated Direct Bilirubin.
Pancreatic Function Test, Amylase level, was within the normal range.
Creatine Kinase (CK) was within the normal range.
Electrolytes and Kidney Function Tests showed decreased Potassium, Sodium, Creatinine, and BUN levels.

We would appreciate your thoughts on these results and the medications the patient is still taking and their potential impact on the patient's condition.
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.

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Jacques
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Re: Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby Jacques » Sun Apr 09, 2023 5:28 am

CancerWarrior_23 wrote:...
We would appreciate your thoughts on these results and the medications the patient is still taking and their potential impact on the patient's condition.

Thank you for creating a signature.

Your brother's cycle-1 lab results look fairly typical to me, but you would have to talk to someone who has actually experienced the FOLFOX+Avastin protocol to get a better idea. Since chemo effects are generally cumulative from cycle to cycle, I think it is usually the 3rd or 4th cycle when patients experience a whopping difference in side effect onset and in lab test out-of-range results. Did the doctor express any concern about these results? How do these results compare with his baseline lab results before the start of chemo?

These lab results are from a standard CBC+differental panel and a standard metabolic panel. The results don't cover other panels that might be of interest, such as a panel of systemic inflamation markers like hCRP, LDH, ESR, etc., or a panel of tumor markers such as CEA, CA19.9 or PSA. Some patients request additional panels that they feel might be of clinical interest. There might be some interest in adding a stool test and a urine test to check for presence of blood, since I think Avastin is generally contraindicated whenever bleeding is present.

As for the five medications he is taking along with the FOLFOX+Avastin regimen, three of them mention "stomach pain/ cramps" specifically, and two of those say that it is urgent to contact the doctor in this case.** Two of the medications say that they should not be taken at the same time as other medications but be separated from other medications by half-an-hour or so. One of the medication package inserts says that the tablets should not be taken with a meal having greasy, fatty foods. So, it's always interesting to read what the manufacturers say about their products.
.
    ** The doctor needs to inform the patient about the dangers of taking high-dose over-the-counter pain meds:
      O Stoma Mia wrote:Newcomers here may not realize that over-the-counter Tylenol (acetaminophen) can be harmful and can cause liver damage. In some cases involving high dosage levels, it can cause acute liver failure.

      Extra-Strength Tylenol and Liver Problems
      Acetaminophen is the active pharmaceutical ingredient in Tylenol, and it has been known for decades to have a toxic effect on the liver at high doses. However, most consumers are not fully aware of this risk and do not appreciate the possibility of liver problems from Extra Strength Tylenol if they take too much of the medication.
      https://www.youhavealawyer.com/blog/2013/07/02/extra-strength-tylenol-liver-problems/

      Acetaminophen and Liver Damage Symptoms
      TYLENOL® is safe when used as directed, but taking too much acetaminophen can cause liver damage.
      https://www.tylenol.com/safety-dosing/health-conditions/liver-disease

      Paracetamol causes most liver failure in UK and US
      Unintentional overdose with the painkiller paracetamol (acetaminophen) is the most common cause of acute liver failure in United Kingdom, a study has found ...Paracetamol’s toxicity is also the single biggest cause of acute liver failure in the United States.
      Those most likely to have acetaminophen induced liver failure are depressed, in chronic pain, misuse alcohol or narcotics, or take several preparations at the same time.
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403265/

      How many Tylenol extra strength would cause an overdose? What could treat the overdose?
      https://www.quora.com/How-many-Tylenol-extra-strength-would-cause-an-overdose-What-could-treat-the-overdose

      Paracetamol Poisoning
      In the United States more than 100,000 cases occur a year. In the United Kingdom it is the medication responsible for the greatest number of overdoses... In the United States and the United Kingdom paracetamol is the most common cause of acute liver failure.
      https://en.m.wikipedia.org/wiki/Paracetamol_toxicity

      Paracetamol Poisoning
      It is important to remember that, when used at therapeutic levels, paracetamol is usually safe and effective. However, taking >100mg/kg or >4 g per day for a few days has been known to result in hepatotoxicity.
      https://patient.info/doctor/paracetamol-poisoning

In my opinion, the main issue with the FOLFOX+Avastin protocol in your brother's case has to do with avoiding a blockage at the primary tumor site that would require emergency surgery. This is because with Avastin, there is usually a 28-day cooling-off period before any surgery can be attempted, so if there is indeed a blockage that needs immediate attention, then the surgeons are going to be in a bind since they will be forced to do a surgery under suboptimal conditions. Of course, I'm not a doctor so my opinion might not carry much weight. But if I were in your brother's shoes, I would want to be very careful about monitoring my diet and preparing meals that are not going to end up as a blockage at the recto-sigmoid junction. That's just my opinion.
Last edited by Jacques on Mon Apr 10, 2023 1:56 am, edited 1 time in total.

Rock_Robster
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Location: Brisbane, Australia

Re: Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby Rock_Robster » Sun Apr 09, 2023 8:22 am

Hi CancerWarrior, thanks for the posts.

Many of the drugs here can be rough on the digestive tract. I’d like to suggest one drug which you may wish to discuss with his doctor, which is commonly marketed as Buscopan (hyoscine butylbromide). It’s available over the counter in the UK, Canada and Australia, but I believe it’s prescription only in the US. Its main role is to dampen stomach contractions/cramping. Given the array of drugs he is on I would not suggest taking it without checking with his doctor and/or pharmacist first, but I’ve seen a lot of chemo patients get enormous relief from this almost immediately. I hope this is of some help, and good luck.

Cheers,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

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Jacques
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Re: Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby Jacques » Tue Apr 11, 2023 11:22 pm

CancerWarrior_23 wrote:...The next chemo session will be on April 11th.

... I have updated my signature with the patient's case information. If you have any tips or thoughts about it, we would appreciate your advice.

How did the April 11th chemo session go? Any news to report?

Regarding your signature, there are still no entries for "Baseline CEA", "MSI status", or "KRAS/NRAS/BRAF mutation status". Normally, for Stage IV patients these data points are captured during the first couple of weeks after diagnosis, and before a decison is made on which 1st-line mCRC treatment regimen to use.

CancerWarrior_23
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Re: Seeking Advice and Suggestions for My Brother's Chemotherapy-Related Stomach Pain

Postby CancerWarrior_23 » Sun Apr 16, 2023 9:54 am

Jacques wrote:
CancerWarrior_23 wrote:...The next chemo session will be on April 11th.

... I have updated my signature with the patient's case information. If you have any tips or thoughts about it, we would appreciate your advice.

How did the April 11th chemo session go? Any news to report?

Regarding your signature, there are still no entries for "Baseline CEA", "MSI status", or "KRAS/NRAS/BRAF mutation status". Normally, for Stage IV patients these data points are captured during the first couple of weeks after diagnosis, and before a decison is made on which 1st-line mCRC treatment regimen to use.


Hi Jacques, thank you so much.

My brother informed me that before his second chemo session, he experienced sweating, but that symptom has since disappeared. He also felt a sense of sluggishness, fatigue, and a lack of energy, which rendered him unable to walk. However, after the second chemo session, he has noticed some improvement and is now able to walk and move around. Also, his sleep quality has improved. In the past, he would sleep for short intervals, frequently waking up and then falling asleep again. Now, he is able to sleep for longer periods without interruption.

I hope this update helps
36M, diagnosed with moderately differentiated invasive adenocarcinoma in sigmoid colon (biopsy on 06/Mar/2023). Multiple hepatic lesions suggestive of liver metastasis (CT Abdomen on 02/Mar/2023) and nonspecific lung micronodules (CT Chest on 02/Mar/2023). Prostate lesion detected in abdominal ultrasound (15/Feb/2023) but not in CT scan (16/Feb/2023). Undergoing treatment with FOLFOX (20% dose reduction) and Avastin; started cycle 1 on 28/Mar/2023 and cycle 2 on 11/April/2023.


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