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What is a DVT and what is a PE?
DVT stands for deep vein thrombosis. “Thrombosis” is the doctorly word for, “clot,” and the deep veins are the larger veins of the legs and arms.
Preventing F & N
There are three basic ways to prevent febrile neutropenia. When appropriate, a regimen with a smaller chance of causing F & N can be chosen. There are two other options: the use of drugs to bring the neutrophil count up, and prophylactic (preventative) antibiotics.
There are two drugs in common usage for lung cancer that can raise the neutrophil count. The first is called neupogen and the second neulasta. I’ve linked to the Amgen page on neulasta because I think that it’s actually pretty helpful. Granted, it’s there to sell more neulasta, but in trying to do so, the page on blood counts makes two very valid points about low blood counts: they can cause direct problems by causing infection, and they can interfere with needed chemotherapy.
How do these drugs work? As we discussed above, the bone marrow is a factory for making blood cells, including the subtype of white blood cells we’ve been talking about—neutrophils. Neupogen and neulasta send an artificial signal to the bone marrow to make more neutrophils, hurry up and get them ready, and release them into the blood. Neuopgen is given every day until the counts have recovered, typically a week or two. Neulasta is a long-acting drug that you only need to give once.
Both drugs, when utilized, are typically started 24 hours after chemotherapy. The package insert for both says that they shouldn’t be used for 14 days before chemotherapy. The reason for this is theoretical—doctors fear that if they send the bone marrow a signal for the blood-making stem cells to divide while chemo is still around, they will risk poisoning these stem cells, actually making the problem worse. This makes a lot of sense, but is it true? While coming back the next day is only a minor nuisance for some of my patients, for others it represents a significant hardship. What do the data say?
As usual, they are not definitive. Four randomized studies compared same day neulasta administration to the usual 24 hours post administration. Studies were done in patients with breast cancer, Non-Hodgkin’s lymphoma, NSCLC and ovarian CA. Overall, there was no clear harm from giving the neulasta the same day:
Introduction
I have asked many patients what side effect of chemotherapy they fear the most. The most common answer is nausea, very closely followed by fatigue (or its cousins such as feeling, “blah,” or the consequences of fatigue such as not being able to do things). I’ve never asked the question of another oncologist, but I suspect that over half would respond, “F&N.”
F & N is not, “fresh and natural,” nor is it, “fries and nutella.” Rather, it’s, “febrile neutropenia.” What is this? Basically, it’s a fever, potentially indicating infection, at a time when blood counts are low.
As a patient, the most important thing to know if you should get a fever while on chemotherapy is to take it seriously. This should be seen as a top medical emergency prompting a visit to the ER and/or a call to your doctor. The reason is that the infections associated with febrile neutropenia can be extremely serious, and can progress quickly. This is not the time to spare your doctor a wake-up phone call in the middle of the night or to spare your partner having to get up and go to the ER. While these infections can be serious, when headed off quickly with IV antibiotics, most patients recover quite well. While definitions of fever vary, 100.4 Fahrenheit is a reasonable threshold.
But why should chemotherapy make blood counts low at all? Tumors grow through division of the cells that compose them. Chemotherapy works by killing rapidly dividing cells. Most cells in the adult body do not divide, and so are less affected by chemotherapy than cancer cells. However, there are a few places in the human body where cells normally divide and are thus affected by chemotherapy—the bone marrow is one of these places. The bone marrow is a factory where special cells called stem cells divide to make all the different kinds of blood cells. Chemotherapy temporarily lowers blood counts by shutting down the blood cell factory in the marrow. Occasionally, chemotherapy can even completely kill one of those stem cells, permanently reducing the speed at which the factory can produce cells. This is why following many cycles of chemotherapy, count recovery can become increasingly sluggish.
Types of blood cells
There are three basic types of cells in human blood: Platelets, red blood cells (aka erythrocytes), and white blood cells.
Hoarseness
Introduction
Thank you to cross-bearer for asking about hoarseness. Hoarseness is any change in voice quality. Most commonly, it is experienced as decreased volume with increased strain. It’s a common problem in lung cancer patients, so common that we’ve discussed it over 40 times in the forums and so I think that it may be time for a proper post discussing it.
There are many causes of hoarseness in the lung cancer patient. Many of these also happen in people without lung cancer, but all are more common in our circles either because of effects of the cancer itself, side effects of cancer treatments, or both.
Normal speech
Speech is produced in the voice box, or larynx.
External view of Larynx
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