Happy Derby Day!
Who needs those "wonderful" Kentucky concotions called mint juleps when you can get a 395mg dose of good ole Tennessee BCNU on Derby Day. They just hooked up Mary Jo's last bag of chemo before the transpant. So, I guess that she's stuck with today's chemo cocktail called BCNU. From looking at the side effects, it is last, but certainly, not the least. Mary Jo's nurse, Gwen, mentioned that the BCNU might make her feel loopy. So, it truly is a chemo cocktail. A green plastic bag covers the bag of BCNU to protect it from light. It is a three hour drip. Although, you cannot tell it from the picture. The YUCKINESS level has decreased considerably. Mary Jo really does feel better this morning. The diarrhea has slowed down. They are testing a stool sample to make sure that she does not have Clostridium Difficile more commonly called C-diff.
Your body has lots of "good" and necessary bacteria. It also has some "bad" or dangerous bacteria. C-diff is a "bad"bacteria. Fortunately, when you are healthy and not taking antibiotics, the millions of good bacteria in your system keep the C-diff under control and in smaller numbers. However, when you take an antibiotic, the levels of good bacteria are reduced down to a smaller number. If your C-diff is strong and doesn't get killed by the antibiotic along with the good bacteria, then it is possible that the c-diff will overpopulate inside your intestine or colon. When this happens, you may get the illness called clostridium difficile colitis when C-diff has taken over. Hopefully, the test will prove to be negative. I think they want to make sure that all the "good bacteria" hasn't been flushed away by the severe diarrhea that she has had for the last 48 hours.
I hope that everyone gets to cash some tickets today. More to come later.
BCNU
Class: Chemotherapy
Generic Name: Carmustine (kar-MUS-teen),
Trade Name: BiCNU®
For which conditions is this drug approved? Carmustine is FDA approved for the treatment of the following conditions: several types of brain tumors (including glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma and metastatic brain tumors); multiple myeloma in combination with prednisone; recurrent Hodgkin’s lymphoma in combination with other agents; recurrent non-Hodgkin’s lymphoma in combination with other agents. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Carmustine belongs to a group of drugs referred to as nitrosoureas. Carmustine produces its anti-cancer effects by causing chemical reactions that result in damage to both DNA and amino acids in a cell. The DNA and amino acid damage caused by carmustine ultimately result in cell death.
How is carmustine typically given (administered)? Carmustine is given intravenously (into a vein), and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient. Carmustine is also produce in a wafer form that can be directly implanted into the brain (see Gliadel® wafer). Carmustine is unique from several chemotherapy agents in that it is able to pass through the blood-brain barrier (a protective barrier surrounding the brain and spinal cord).
How are patients typically monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with carmustine. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems such as the liver and kidneys. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy. Although uncommon, treatment with carmustine may cause serious damage to the lungs. Therefore, pulmonary function tests may also be performed prior to treatment and during treatment with carmustine. Blood pressure is typically monitored during administration.
What are the common (occur in 30% or more of patients) side effects of treatment with carmustine?
• Low white blood cell levels – increases risk of infection
• Low platelet levels – increases risk of bleeding
• Nausea and vomiting
• Pain or burning at administration site, usually associated with rapid infusion rate
• Redness of face, skin flushing, usually associated with rapid infusion rate
What are the less common (occur in 10% to 29% of patients) side effects of treatment with carmustine?
• Abnormalities in liver function levels as determined by blood tests; hepatic disease with high dose therapy
• Low red blood cell levels – increases risk of anemia and transfusions
• Dizziness
• Loss of balance or coordination
• Abnormalities of the eye (redness, visual changes)
• Reduced blood pressure
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What are the possible late side effects of treatment with carmustine? With the use of this drug, there is risk of developing side effects months or years after treatment has been completed. In some instances a secondary malignancy may occur as a result of receiving carmustine. A secondary malignancy is a new cancer that is unrelated to the cancer that was initially treated. Secondary malignancies occur as a result of previous treatment with radiation or chemotherapy. Sterility may also occur as a result of treatment with carmustine. In addition, damage to the lungs can occur years following treatment. Patients should discuss these late side effects with their physician.
What can patients do to help alleviate or prevent discomfort and side effects?
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• Eat small meals frequently to help alleviate nausea.
Are there any special precautions patients should be aware of before starting treatment?
• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Since this drug can cause dizziness or loss of coordination, patients should refrain from driving or operating heavy machinery until their response to therapy with carmustine has been established.
When should patients notify their physician?
• Fever
• Chills
• Flu or cold-like symptoms
• Signs of infection – redness, pus, swelling, tenderness
• Sore throat
• Severe, prolonged fatigue
• Unexplained bleeding (nosebleeds, blood in urine, black tarry stools, bruising, etc.)
• Visual changes
• Hearing changes
• Dizziness, loss of balance
• Yellowing of skin or eyes
• Change in color or urine or stool
• Swelling of ankles, feet or face
• Persistent nausea and vomiting
• Difficulty breathing
I am thinking this may have been a condition that she has had for awhile and the chemo and other drugs, along with, the extreme diarrhea that she had for several days, not eating properly, and not getting a good night's sleep in the hospital, in addition to the stress of what she is going through hasn't exacerbated a pre-existing condition. 
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