Diffuse large B Cell Lymphoma: Days 9 to 11 after Chemotherapy

Patient health condition from days 9 to days 11 after chemotherapy ( R-CHOP)

Days 9:
on this days patient complaining of slight fever and watery stool. She pass motion about 5 time since early morning. Immediately we go to Normah Specialist centre, accident and Emergency clinic. There she was diagnose and found out that her body temperature was 38.6 deg. and only 0.4 white blood count (WBC). The doctor then informed us that she had to be admitted due to the very low WBC. She was admitted to Sarawak General Hospital on the same day and was given medicine to boost her white blood cell production.

Days 10:
Doctor review the patient condition.She been put under antibiotic and been given medicine to boost the production of her White blood cell. Later of the day her blood sample was taken to check on the WBC and other parameter which is essential to plan for further treatment on her. She was also given medicine to fight against the fever.She was also been given medicine to treat her diarrhoea.

Days 11:
Her condition is improving. She still having on and off fever. However she still having Diarrhoea.

This is a quick history of the the diffuse Large B cell Lymphoma.

Diffuse Large B Cell Lymphoma : Days 7 to 8 patient health condition.

DLBCL Patient health condition days 7 and 8: (21th March 2013 to 22nd March 2013)

It had been 8 days since the chemotherapy with R-CHOP Regime had Started.As mentioned in earlier article, she still having sore throat, headache and passing watery stool. However the watery stool condition, I assume that it is not to the situation called diarrhea. she still having good apatite accept that she need to take soft food because of her sore throat. 

Since the first day of the Chemotherapy it was hardly been notice that she loosing her hair as what we usually heard. Thank God for that. this situation I consider that the hair fall is so much depend on the dosage prescribe by doctor as to match the cancer stage. May be it also due to the body condition that still be able to tolerate the chemotherapy regime.

Index Finger.

A few things that are noticeable with my wife condition are she seem like emotionally stressful due to the treatment. Another situation is that she having situation that sometime she become absent minded and also she always complaint of body ache and numbness at her right hand index finger. At night she normally telling me that her heart beat faster than normal but it does not prolong. Honestly I do not know whether this is one of the side effect of this chemotherapy treatment. 

On the daily diet she take, it is almost as usual accept that she taking more fruits and reduce taking much fatty foods such as fried foods. There is no more overnight food for her, no more fast food as our usual lifestyle which we having dinner outside at least once a week. This all due to hygienic factor. Remember this. A person that goes through chemotherapy has very weak body defence hence avoid to be in a congested public area such as shopping mall,markets or even health clinic ( do not go to clinic or hospital if it is not necessary).If the person need to be at this location at least get her to use musk and always bring along hand sanitizer.

The most important role that I and all of our family members and not forgetting also all of our friends is give all of our support to lift up her spirit in enduring this difficult times. There is no other replacement to this moral support. As all we know, recovery process not only depends on medicine but also not to put patient into depression mode. "Laughter is the best medicine". There is lots of information being publish with regards to the side effect of chemotherapy treatment.

This article is just an information what my wife had gone through while she is undergo her chemotherapy treatment for her Diffuse Large B cell Lymphoma (DLBCL).

Diffuse Large B cell Lymphoma (R-CHOP) : 6 days after R-CHOP

The standard treatment for Diffuse Large B cell Lymphoma is Chemotherapy. My wife had been advised by our doctor to undergo this standard treatment as soon as possible just because this type of Lymphoma is an aggressive type. It can attack other part of the body without any warning or symptom until you feel sick. She had been suggested the R-CHOP regime for his Chemotherapy by her doctor.

Day 1: 15th of March 2013
My wife and I went to see the doctor to start the first cycle of Chemotherapy. She was admitted as out patient in day care ward. Before starting the R-CHOP regime my wife was given the anti-allergy drug. Her condition before and after the administered of the anti-allergy drug remain good.

After the Anti allergy drug, Then the first drug for the R-CHOP regime was given to my wife. There is no unusual sign shown by my wife. everything is good. Until finishing the whole dos of R-CHOP regime she was still in very good condition except that a bit dizzy but then she had been recovered.

The first day of her Chemotherapy had been good. She was discharge and prescribe with Prednisolone, Anti nausea, and Multivitamin. Doctor advise not to take any other herbal medicine prior to any consultation with him cause this might interfere with the treatment and might cause adverse effect to the patient.  Another advice is to make sure that the environment where she were is Hygienic. Try to avoid places like markets, have distance with those that having Cough, Fever, Flu or any communicable diseases.

Day 2 until day 3 : 16th March until 18th March 2013
My wife condition remain good. She still having good apatite.( Most of the patient that undergo Chemotherapy had been reported to have lost of apatite)

Day 4 until day 6 : 18th March until 20th March.
The effect of the R-CHOP shown some sign. Her sense of taste start to gone but she still have apatite. She feel tasteless unless she consume something with the sour taste. The following days She feel pain at her throat area. I suspect it is sore throat as it is another side effect of the Chemotherapy. Last night she complaint of stomach paint and she went to pass s***. As expected, it is not as per normal solid but liquid. Is it Diarrhea? I am not certain. Diarrhea is a condition of a person passing watery stool frequently. In other words at least 3 time a day. From middle of last night until this morning (20th March 2013) she only had it once. Hopefully that is the only one time. Diarrhea is also one of the side effect of Chemotherapy.

Diffuse Large B Cell Lymphoma Treatment (R-CHOP)

Diffuse Large B Cell Lymphoma (DLBCL) is a most common type of Non-Hodgkin Lymphoma (NHL). The treatment for this Blood Cancer is by under-go Chemotherapy. To be more specific the chemotherapy is the combination of Rituximab,  Cyclophosphamide or also called cytoxan or Neosar, Doxorubicin( or Adriamycin), Oncovin (or Vincristine) and Prednisolone. The combination of this drug is call R-CHOP.

What is Rituximab?Rituximab is a special group of controlled drugs called "monoclonal antibodies".The goal of Ritxumab is to inactivates the defective B-Cell and eliminates them. Rituximab only targeted molecule called CD20 that present on the surface of B-cell. Because of this very spefici function, it does not produce ill effects on nornal cell in the body.

Cylophosphamide or cytoxcan is a powder that dissolves to form colourless liquid.It is belongs to a class of drugs known as alkylating agents.Cyclophosphamide blocks the production of the deoxyribonucleic acid (DNA) in cells which resulting to the cell cannot reproduce new cell. Thus it leading to the cell death. Some of the cells affected by this medication are immune cells.

Doxorubicin is an anthracycline antibiotic with antineoplastic activity.Doxorubicin works by stopping the cancer cells from dividing and multiplying. This kills the cancer cells and stops the cancer growing. How does this doxorubicin works is not known but it seems to it jobs in three ways. Firstly, it bind into the strands of genetic material (DNA) inside the cancer cells. This prevents the cells from making genetic material (DNA and RNA) and proteins. It also appears to interfere with an enzyme called topoisomerase II, which is involved in DNA replication. This stops the cancer cells growing and multiplying. Finally it can also form free radicals, which are molecules capable of damaging the cancer cells.

Unfortunately, anticancer medicines also affect normal, healthy cells, particularly those that multiply quickly such as blood, gut and hair cells. The most important side effect is usually on the bone marrow where blood cells are made. Doxorubicin can decrease the production of white blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor levels of blood cells.

The doxorubicin in this medicine is contained in tiny spheres called pegylated liposomes. These spheres allow the doxorubicin to remain in the bloodstream for longer so that a greater amount is delivered to the cancerous cells, rather than to healthy tissue. This may result in fewer side effects than standard doxorubicin.

Oncovin or Vincristine is administered intravenously and is used to treat many different types of cancer. Vincristine binds to the tubulin monomers preventing the formation of spindle microtubules. By binding to the building blocks of microtubules, vincristine disables the cell's mechanism for aligning and moving the chromosomes. Vincristine stops the separation of the duplicated chromosomes and prevents cell division. While vincristine works to keep the cancer cells from dividing, it does not selectively inhibit cancer cell division. It can also halt the division of some healthy cells, leading to some of the common side effects.

Prednisolone is chemically related to Hydrocortisone, one of the steroid hormones produced by the adrenal gland (adrenal cortex) which plays a complex role in regulating body functions.One way that it works is to decrease inflammation (swelling).  It does this by preventing infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. (This is why you are more prone to infection while taking steroids).  Taking advantage of the anti-inflammatory properties of the medication, corticosteroids are used to decrease the swelling around tumors.  For example, by decreasing swelling around tumors in the spine, brain, or bone, it can decrease the pressure of the tumor on nerve endings and relieve pain or other symptoms caused by the pressing tumor.

Another way Prednisolone works is by altering the body's normal immune system responses.  Corticosteroids are used to treat certain conditions that effect the immune system such as aplastic anemia (AA), Immune Thrombocytopenia Purpura (ITP), Thrombotic Thrombocytopenia Purpura (TTP), or hemolytic anemia.

In addition, it is thought that corticosteroids may help in the treatment of patients with blood disorders, such as multiple myeloma.  Corticosteroids may work by causing programmed cell death (apoptosis) of certain cells, which may help to fight your disease.

Corticosteroids are also used in the short-term treatment of nausea caused by chemotherapy.  How it does this is not fully understood.  They also have been used to stimulate appetite for patients with severe appetite problems.

Notes: The information above is copy from numberous website and I reserve no right on all of this work. It is just an attempt to provide useful information to cancer pation with Diffuse Large B- Cell Lymphoma. My Lovely wife is one of the cancer patient. She is suffering DLBCL.