Infection and markers

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IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Thu Mar 09, 2023 11:37 am

rp1954 wrote:Why the 50 gram C dose vs 75g C?

Initially it was because vitamin C was supplied in 50ml vials / 25mg per vial. So 25, 50, 75 or 100 was just convenient. But you are right, it doesn't matter, we can do any. I did 80g yesterday - plasma concentration showed 26 mM.

rp1954 wrote:What is her IV vit C timing with relation to Folfox/Folfiri infusions (and 46 hr 5FU)?

If I understand your question correctly, 500ml solution (50g vit. C plus MgCl2, KCl, CaCl2) usually takes 2 hours, which is ~0.4g/min. 750ml solution for 75g vit. C we do 2.5-3 hours. Actually we can speed it 2x times up to 1g/min to increase peak concentration. I'm not sure what is better - high, but short peak concentration vs longer time infusion with lower peak.

rp1954 wrote: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?

I setup pump to 250-270 ml/hr. Not a problem to change it if needed.
We do bloodwork usually next day, within 24 hours after IVC.
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

rp1954
Posts: 1861
Joined: Mon Jun 13, 2011 1:13 am

Re: Infection and markers

Postby rp1954 » Thu Mar 09, 2023 2:36 pm

IM64 wrote:... we can do any. I did 80g yesterday - plasma concentration showed 26 mM.

So at this point you have a nurse that's listening to you directly?
Is this now DIY insertion, an independent contractor or still ND's employee?

rp1954 wrote:What is her IV vit C timing with relation to Folfox/Folfiri infusions (and 46 hr 5FU)?

I'm still struggling with the fine details of your wife's Folfox/Folfiri cycles including dates and timing. This affects interpretation and later comparisons.
Btw, what kind of infusion setup for chemo, central venous and power pump or the older lines affair?

IM64 wrote:...500ml solution (50g vit. C plus MgCl2, KCl, CaCl2) usually takes 2 hours, which is ~0.4g/min. 750ml solution for 75g vit. C we do 2.5-3 hours. Actually we can speed it 2x times up to 1g/min to increase peak concentration. I'm not sure what is better - high, but short peak concentration vs longer time infusion with lower peak

The psychological burden of long term frequent IV is such that I focused on patient preferences to maintain momentum and morale. My wife is impatient and would run fast, often over 1 gram minute, sometimes probably scorching her veins but that is modified with higher magnesium concentration. I'm not sure how calcium affects the vein comfort. For right now, just track what you are doing and write notes, so you can track differences over time.
What is the sequence and separation between Folfox/Folfiri and IV C. Since my wife was oral chemo 3x a day, we overlapped.
Does IV C over lap in the chemo infusion hardware or she uses separate infusion sites?

rp1954 wrote: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?

I setup pump to 250-270 ml/hr. Not a problem to change it if needed.
We do bloodwork usually next day, within 24 hours after IVC.

From my point of view, there's trying to get a degree of consistency, simply tracking what's happening, and, longer term, some degrees of optimization for sampling and for treatment.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Thu Mar 09, 2023 8:51 pm

rp1954 wrote:So at this point you have a nurse that's listening to you directly?
Is this now DIY insertion, an independent contractor or still ND's employee?

That is a mix - something DIY, something with independent nurse. Within reasonable limits, I can decide things like a dose, infusion rates, when and how often do it. Or I will need ND advice for more complicated questions.

rp1954 wrote:What is her IV vit C timing with relation to Folfox/Folfiri infusions (and 46 hr 5FU)?
Btw, what kind of infusion setup for chemo, central venous and power pump or the older lines affair?

She has standard two weeks Folfox/Folfiri protocol. All infusions started on Monday afternoon and finished on Wednesday afternoon, and once we had one week delay due to bleeding. Actual infusions dates are: Folfox - Oct. 24, Nov. 7, 21, Dec. 5, 19, Jun. 3, 16, Feb. 6, 21. Folfiry - Mar. 6
In hospital she gets IV oxaliplatin/irinotecan plus leucovorin, and 46-hour pump ("baby bottle") connected with 5FU. PICC is line used for all infusions.

rp1954 wrote:For right now, just track what you are doing and write notes, so you can track differences over time.

Sure, I do small notes from the first day with all side effects and all additional treatments.

rp1954 wrote:What is the sequence and separation between Folfox/Folfiri and IV C. Since my wife was oral chemo 3x a day, we overlapped.
Does IV C over lap in the chemo infusion hardware or she uses separate infusion sites?

Both IV-C and chemo use PICC line now. When we did IV-C in the IV clinic, they did it simultaneously in the other hand. At home we do IVC Monday morning before chemo (starts afternoon), break on Tuesday, and continue on Wednesday afternoon after pump is disconnected.

rp1954 wrote:From my point of view, there's trying to get a degree of consistency, simply tracking what's happening, and, longer term, some degrees of optimization for sampling and for treatment.

Yes, I understand. We started IVC from December 15. And it was just 1-2 times per week at the beginning. So time from IVC to bloodwork may be different. Stably 3-4 times per week started from January.
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

rp1954
Posts: 1861
Joined: Mon Jun 13, 2011 1:13 am

Re: Infection and markers

Postby rp1954 » Fri Mar 10, 2023 9:02 am

I would continue to shop for experienced support and run things by integrative MDs and NDs in a nonthreatening environment.

I don't know about referrals, telemedicine and insurance for consults in Canada.
These were mentioned for a member on these forums that was treated with Folfiri + (IVC + K3), somewhere:
Abbotsford Cancer Clinic, the Integrated Health Clinic, Fort Langley, BC

For the first two Folfiri tx, I would get the extra liver, inflammation panels, etc to better measure and examine Folfiri's benefits, toxicities and side effects vis a vis potential ADAPT formulations.

At least the current onc sounds supportive on Xeloda although his written scrip for a big dose may be an issue. I believe US patients get cash orders for extra capecitabine from Canadian mail order pharmacies.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Fri Mar 10, 2023 12:58 pm

Thanks for advice
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin


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