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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 46682
Experience:  Board Certified Oncologist
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Can weekly paclitaxel be prescribed without h1 and h2

Customer Question

can weekly paclitaxel be prescribed without h1 and h2 antagonists. Can dexamethasone be given a few minutes before rather than 30 minutes before? Is heart failure a common occurrence?
Submitted: 1 year ago.
Category: Oncology
Expert:  Dr. David replied 1 year ago.
This is Dr. Davidwhy don't you want an antihistamine?how is your heart currently? what is your ejection fraction?
Customer: replied 1 year ago.
no its in relation to a relative. She had weekly paclitaxel at 50 mg per m2. She didn't have any anti-histamines, just dexamethasone, but it was given a few minutes before via an "electric syringe machine" over 8 minutes. They then used set up the paclitaxel on the syringe machine.
What is ejection fraction?
What are the normal bloods that are used to determine if someone can have paclitaxel? Is it ast and alp?
Customer: replied 1 year ago.
i.e dex was not give 30 minutes before, maybe started 10 mins before over 8 mins
Expert:  Dr. David replied 1 year ago.
ejection fraction is a measurement of how efficient the heart beats out blood. patients who have lower ejection fractions are more at risk for heart failure.medical oncologist will check a patients WBC white blood cell count and hemoglobin and hematocrit and platelets to make sure the bone marrow is making proper cells. ast and alt are used to check liver function.creatinine and BUN levels are also checked to check for proper kidney functiondex can be given a few minutes before.let me know if you have other questions.if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you todaywe only get credit for helping clients after positive feedbackyou can always reach me with "a question for Dr. David" in the medicine or oncology categories if you have any other questionshere is my website if you need to reach me again:http://www.justanswer.com/medical/expert-dr-david/Thanks for using JustAnswers.com
Customer: replied 1 year ago.
But can it be given without antihistamines, you even asked me why we didn't want it.
Also according to the presciption dex was supposed to be given a minimum of 30 mins before due to half life. Is there a risk of harm if given immediately before paclitaxel.Shehad high ast, alp creatinine and high white blood cells. Her heamglobin was low (8mg)
Expert:  Dr. David replied 1 year ago.
yes, it can be given without antihistamine.there is no risk if dex is given right before paclitaxel.how high are her ast, alt, creatinine and WBC levels? hemoglobin of 8 is a bit too low. she might need a blood transfusion.
Customer: replied 1 year ago.
my worry is something went wrong. She developed rapid short breaths and weakess soon after the effusion started. She then became confused and a x-ray revealed pulmonary oedema on the right lung
8.9 hb (g/dl)
12.87 wbc (10>9/l)
neutrophils 10.97
alt 69
ast 124
alkaline phosphatase 323
urea 25.1 (mmol/l)
creatinine 136 (umol/l)
Expert:  Dr. David replied 1 year ago.
her hemoglobin levels were too low at 8.9this anemia can cause shortness of breath.she shouldn't have had chemotherapy with such a low hemoglobin level.WBC was elevated. she could have had an infection. you don't get chemo when there is a risk for infection.so the chemo shouldn't have been given.
Customer: replied 1 year ago.
yes I thought so. The notes say small chance of working might make her worse and limits of fitness, she knows the risks and she's agreed. But they didn't say any of this. they said there were general side effects (hair loss infection pheirphal neurooathy) but not that she was unfit or limit of fitness. I don't kno what worse means, fatal?
Expert:  Dr. David replied 1 year ago.
chance of fatality is low. but extra risk shouldn't be taken by giving chemotherapy when a patient has low red blood cell count and high white blood cell count.let me know if you have other questions.if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you todaywe only get credit for helping clients after positive feedbackyou can always reach me with "a question for Dr. David" in the medicine or oncology categories if you have any other questionshere is my website if you need to reach me again:http://www.justanswer.com/medical/expert-dr-david/Thanks for using JustAnswers.com
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Customer: replied 1 year ago.
dr david, she died within hours of it being given. She already had breathlessness from pleural effusions and crackles on eamination. However, they said she was fine. After it was given her breathing became more rapid and she was very weak complaining or back pain lower back and was easily injured. When a doctor eventually examined her he though fluid was seeping into the right lung and thought it was heart failure or aspiration pneumonia. Is it possible the chemo caused this.
The SHO later said it was chemo induced heart failure but the consultant deneied this saying chemo would not have any ill effects for days
Expert:  Dr. David replied 1 year ago.
it should not have been given if she had low hemoglobin and elevated WBC counts and potential for infection.she should have had an autopsy which could have given more information about heart damage and chemo toxicity in her body possiblydid she have an autopsy?
Customer: replied 1 year ago.
no they said death was not suspicious, we see this in outpatients they are well, then they suddenly deteriorate and die.
Customer: replied 1 year ago.
it was 50mg/m2 and also her weight was officially 75kg, but the weight used was 60kg. the reason the weight was lowered was because she had massive fluid overload, abdomen legs and left arm. They had previously (until 3 weeks before) used xeloda and compression garments to control it. However, ever new medical team used diuretics (furosemide 80mg) tablet and iv. The furosemide did not work and caused renal failure and dehydration so they couldn't restart xeloda.They then stopped and restarted diueretics when the kidneys improved. She got renal failure again. However, they stopped it 2 days before they gave paclitaxel. The creatinine however continued to rise after they stopped the furosemide the 2nd time. They thought the lymph nodes were pressing on one kidney but the renogram did not show any obstruction and they wanted to start the paclitaxel.Is it ethical to give chemo in this state. The notes say small chance of working might make her worse, does this sound likely to be fatal?
Expert:  Dr. David replied 1 year ago.
she was very sick at that time. fluid overload, kidneys dehydrated. renogram gives contrast which taxes the kidneys more.probably not the best idea to give chemo at that point in time the chemo did make her worse.
Customer: replied 1 year ago.
also a palliative consultant saw her on the day of the chemo and said he didn't think she was fit. We decided to stop it. He put in the notes told the family " treatment is riskier than no treatment, they understand and want to discuss or resume"However the oncologist said he was wrong she was fit, and if we didn't start now we couldn't start later but its your choice. She however, put in the notes patient at limits of fitness, initially didn't want it but husband very vocal she should, so she did. This is not true, whether we can prove it or not. All she said was its your choice, I checked her this morning she's fit, her bloods are fine if you don't start now you can't start later.We feel guilty and that we fell for it. But we didn't know her bloods were not in the acceptable range, we didn't know you needed antihistamines and that dexamethasone should have been given 30 minutes before
Customer: replied 1 year ago.
she said he was palliative and he didn't know her.I'm sorry for going on but this is very upsetting and we need an understanding. Ethically can you give treatment when it has a small chance of working, treatment is riskier than no treatment. This comes across as some form of elective euthanasia
Expert:  Dr. David replied 1 year ago.
her oncologist should not have put pressure on you to make decision to give chemo or not.that is not morally correct.her oncologist where wrong. she was not fit. her creatinine levels were rising. her WBC count was up.
Customer: replied 1 year ago.
have you ever seen chemo given in such circumstances? Would you do it? This comes across as some form of elective euthanasiais this even legal? Ethically can you give treatment when it has a small chance of working, treatment is riskier than no treatment.
Customer: replied 1 year ago.
Sorry just to add they put in the notes you do not need the liver or kidney for paclitaxel. Is this true? You seem to think you do need the kidney.Also, her legs had fluid pouring out and were very sore
Expert:  Dr. David replied 1 year ago.
most chemo doctors would not have given chemo.I would not have given.euthanasia should not be done like that.legality is something for the courts and lawyers to decide. I don't think it was ethical to give the decision up to the family who does not have medical training.you do need the liver and kidneys for paclitaxel to be given.
Customer: replied 1 year ago.
thank you dr davd, this matter is very difficult and you have been helpful in answering my questions. I get from what you are saying this was wrong and was given with a view to end the patients life?I am considering complaining about the Dr to the GMC. Would that be a worthwhile thing to do, (even if they take no action)? I don't want to be malicious in complaining.I get she was terminally ill, but I don't think a doctor should be allowed to practice like this, or maybe I am wrong.
Expert:  Dr. David replied 1 year ago.
you can complain about the doctor to the GMC.please leave positive rating of 3-5 stars so I can get credit for helping you todaywe only get credit for helping clients after positive feedbackyou can always reach me with "a question for Dr. David" in the medicine or oncology categories if you have any other questionshere is my website if you need to reach me again:http://www.justanswer.com/medical/expert-dr-david/Thanks for using JustAnswers.com
Customer: replied 1 year ago.
Its not letting me rate, but I rate positive.Last q, I can rate this separately as well so you are credited for the below separately as well.Would you complain if this happened to you? And what should the focus be, prescribing without pre-meds, prescribing when she was so unwell or giving the decision to the family. They seem to cover themselves by saying she and we knew the risks, and we cant disprove this other than saying they didn't tell us.
Expert:  Dr. David replied 1 year ago.
it is up to you if you want to complain or notit sounds like you have not gotten over this passing of your relativemost cancer doctors reviewing the medical record would not agree to give chemo if the WBC count is above 10 and if the hemoglobin level is low.