Doctors prescribe Celebrex celebrex to celebrex treat pain, swelling, and celebrex dosage dosage stiffness of dosage arthritis and some other conditions. Nsaids should be avoided or withdrawn whenever possible. Hepatic Impairment The dosage daily recommended dose of celebrex dosage capsules in dosage patients with celebrex moderate hepatic impairment (Child-Pugh Class B) should be reduced. All patients were prescribed open-label esomeprazole (20-40 mg) for gastroprotection. Alternative management should be considered in celebrex JRA patients identified to be CYP2C9 celebrex poor metabolizers. Professional resources, related treatment dosage guides). When these dosage drugs are administered concomitantly, patients should be adequately hydrated. The JRA DOI 30 response rates dosage dosage at week 12 were 69, 80 and 67 in celebrex the celebrex celecoxib 3 mg/kg twice daily, celecoxib 6 mg/kg twice daily, and naproxen.5 mg/kg twice daily treatment groups, respectively. The cumulative rates dosage in non-ASA users at nine months in each of the celebrex three treatment groups were less than. Renal Toxicity And Hyperkalemia Renal Toxicity Long-term administration of nsaids has resulted in renal celebrex papillary necrosis and other renal injury. This risk may happen early in treatment and may increase: with increasing doses of nsaids with longer use of nsaids Do not take nsaids right before or after a heart surgery called a coronary celebrex artery celebrex bypass graft (cabg). Intervention: During concomitant use of celebrex and digoxin, monitor serum digoxin levels. Celebrex doses of 100 mg twice daily and 200 mg twice daily were similar in effectiveness and both dosage were comparable to naproxen 500 mg twice daily. Management of Acute Pain and Treatment of Primary Dysmenorrhea. The sprinkled capsule contents on celebrex applesauce are stable for up to 6 hours under refrigerated conditions dosage (28 C/ 3545 F). Do not exceed the dose recommended by your doctor. Table 1: Adverse Events Occurring in 2 of celebrex Patients from Pre-marketing Controlled Arthritis Trials CNX N414 6 Placebo N1864 NAP N1366 DEF N387 IBU N345 Gastrointestinal Abdominal Pain.22.214.171.124.0 Diarrhea.6.8. The 100 mg capsules come in blister packs. Population pharmacokinetic analysis indicated that the oral clearance (unadjusted dosage for body weight) of celecoxib increases less than celebrex proportionally to increasing weight, with 10 kg and 25 kg patients predicted to have 40 and 24 lower clearance, respectively, compared with a 70 kg adult RA patient. Table 4 : Summary of Single Dose (200 mg) DispositionKinetics of Celecoxib in Healthy Subjects1 Mean (CV) PK Parameter Values Cmax, ng/mL celebrex Tmax, hr Effective t, hr Vss/F, L CL/F, L/hr 705 celebrex (38).8 (37).2 (31) 429 (34). Osteoarthritis, for OA, the dosage is celebrex 200 mg per day administered as celebrex a single dose or as 100 mg twice daily. Based on celebrex animal data, prostaglandins have been shown dosage to have an important role in endometrial vascular permeability, blastocyst implantation, and decidualization. The cause and clinical significance of this finding is unknown. In dosage some patients with systemic onset JRA, both celecoxib and naproxen were associated with mild prolongation of activated partial thromboplastin time (aptt) but not prothrombin time (PT). Monitor patients with preexisting asthma (without aspirin sensitivity). Manage patients with symptomatic and supportive care following an nsaid dosage overdosage. Many medicines used to treat headache, period pain and other aches and pains contain aspirin or an nsaid. The 200 mg capsules come in blister packs of 10 and. Ankylosing spondylitis 100 mg twice daily or 200 mg once daily. The increases in both celecoxib dose groups versus placebo-treated patients were mainly due to an increased incidence of myocardial infarction see Clinical Studies. For AS, the dosage of celebrex is 200 mg daily in single (once per day) or divided (twice per day) doses. Ask your doctor celebrex or pharmacist if any of this applies to you. Clinical trials of other COX-2 dosage selective and non-selective nsaids of up to three-years duration have shown an increased risk of serious cardiovascular celebrex thrombotic celebrex events, myocardial infarction, and stroke, which can be fatal. Celebrex was dosage evaluated for treatment of the signs dosage and the symptoms of OA of the knee and hip in placebo-and active-controlled clinical trials of up to 12 weeks duration. Cardiovascular Thrombotic Events Advise patients to be alert for the symptoms of cardiovascular thrombotic events, including chest pain, shortness of breath, celebrex weakness, or slurring of speech, and to report any of these symptoms to their celebrex health care provider immediately see warnings celebrex AND precautions. Is There Anything Special I Should Discuss With My Doctor Before Taking Celebrex? In animal studies, administration of prostaglandin synthesis inhibitors such as celecoxib, resulted in increased pre-and post-implantation loss. Cautions, congestive heart failure, hypertension, increased risk of adverse cardiovascular events celebrex and skin reactions. Further dosage information, always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The effective half-life is approximately 11 hours under fasted conditions. If you're a woman, let your doctor know if you are or may be pregnant, or if you're breastfeeding. Right before or after heart bypass surgery. Warnings and Precautions (5). Table 7 also displays results for patients less than or greater than 65 years of age. What celebrex is used for, celebrex is used to relieve the symptoms of joint pain, tenderness, swelling and stiffness in: osteoarthritis rheumatoid arthritis ankylosing spondylitis, a chronic inflammatory rheumatic disorder that primarily affects, but is not limited to, the spine. ACE dosage Inhibitors and ARBs : Concomitant use with celebrex in the elderly, volume depleted, or those with renal impairment may result in deterioration of renal function. Pediatric The steady state pharmacokinetics of celecoxib administered as an investigational oral suspension was evaluated in 152 JRA patients 2 years to 17 years of age weighing 10 kg with pauciarticular or polyarticular course JRA and in patients with systemic onset JRA. Do not take nsaids: if you have had an asthma attack, hives, or other allergic reaction with aspirin or any other nsaids. Cumulative rates for this composite endpoint over 3 years were.3 (21/933 subjects) and.9 (12/628 subjects respectively. Osteoarthritis: The recommended daily dose of celebrex (celecoxib) is 200 mg administered as a single dose or as two divided doses (100 mg twice per day). Elevations of ALT or AST (less than three times ULN) may occur in up to 15 of patients treated with nsaids including celecoxib. Gastrointestinal Bleeding, Ulceration, And Perforation Advise patients to report symptoms of ulcerations and bleeding, including epigastric pain, dyspepsia, melena, and hematemesis to their health care provider. Only one in five patients who develop a serious upper GI adverse event on nsaid therapy is symptomatic. Cardiovascular Outcomes Trial: Prospective Randomized Evaluation of Celecoxib Integrated Safety. Maximum dose 400 mg a day for up to 7 days. Warnings and Precautions, post-MI Patients : Avoid the use of celebrex in patients with a recent MI unless the benefits are expected to outweigh the risk of recurrent CV thrombotic events. Celecoxib is hydrophobic (log P.5) and is practically insoluble in aqueous media at physiological pH range. Clinical Studies, rheumatoid Arthritis (RA for the management of the signs and symptoms of RA see. No substantial differences in effectiveness were observed between these subjects and younger subjects. The incidence of endoscopic ulcers in patients taking celebrex 200 mg twice daily was. Special Populations, poor Metabolizers of CYP2C9 Substrates, in adult patients who are known or suspected to be poor CYP2C9 metabolizers based on genotype or previous history/experience with other CYP2C9 substrates (such as warfarin, phenytoin initiate treatment with half of the lowest recommended dose. Adverse Events From Analgesia And Dysmenorrhea Studies Approximately 1,700 patients were treated with celebrex in analgesia and dysmenorrhea studies. The mechanism of action of celebrex is believed to be due to inhibition of prostaglandin synthesis, primarily via inhibition of cyclooxygenase-2 (COX-2). Doses up to 400 mg once daily were studied. The difference in rates between celebrex alone and celebrex with ASA groups may be due to the higher risk for GI events in ASA users. Hepatic Impairment A pharmacokinetic study in subjects with mild (Child-Pugh Class A) and moderate (Child-Pugh Class B) hepatic impairment has shown that steady-state celecoxib AUC is increased about 40 and 180, respectively, above that seen in healthy dosage control subjects. Cardiovascular safety outcomes were also evaluated in the class trial. Avoid administration of more than one nsaid at a time. A dosage adjustment may be warranted celebrex when celecoxib is administered with CYP2C9 inhibitors or inducers. Race Meta-analysis of pharmacokinetic studies has suggested dosage an approximately 40 higher AUC of celecoxib in Blacks compared to Caucasians. You may report side effects to FDA at 1-800-FDA-1088. Celebrex was evaluated for treatment of the signs and symptoms of RA in placebo-and active-controlled clinical trials of up to 24 weeks in duration. At 50 mg/kg/day (approximately 6-times human exposure based on the AUC0-24 at 200 mg twice daily) there was increased preimplantation loss. In the celebrex groups, the endoscopic ulcer rate appeared to be higher in aspirin users than in non-users. Always tell your doctor if you have allergies to any medications. Patients taking angiotensin converting enzyme (ACE) inhibitors, thiazide diuretics or loop diuretics may have impaired response to these therapies when taking nsaids see drug interactions. Management of Acute Pain: The recommended dose of celebrex is 400 mg as a single dose on the first day followed by 200 mg once daily on subsequent days up to a maximum of 7 days. Avoid the use of celebrex in patients with advanced renal disease unless the benefits are expected to outweigh the risk of worsening renal function. Prostaglandins sensitize afferent nerves and potentiate the action of bradykinin in inducing pain in animal models. These dosage changes resulted in a statistically significant and clinically meaningful difference.9 mmHg (p0.0009) between celecoxib and ibuprofen and a non-statistically dosage significant difference.8 (p0.119) mmHg between celecoxib and naproxen. This Medication Guide has been approved by the.S. Caution should be exercised when celebrex is administered to a nursing woman. Storage And Handling celebrex (celecoxib) 50 mg capsules are white, with reverse printed white on red band of body and cap with markings of 7767 on the cap and 50 on the body, supplied as: NDC Number Size bottle. Use caution in pediatrics with systemic-onset juvenile idiopathic arthritis; serious adverse reactions, including disseminated intravascular coagulation reported. Dosing Considerations, cardiovascular disease or cardiovascular risk factors: Treatment with celebrex, particularly at doses higher than 200 mg per day, should not be used in patients with pre-existing cardiovascular disease (congestive heart failure (nyha II-IV ischemic heart disease cerebrovascular. Intervention: During concomitant use of celebrex with diuretics, observe patients for signs of worsening renal function, in addition to assuring diuretic efficacy including antihypertensive effects see warnings AND precautions. You may take Celebrex for up to 5 days. Patient Counseling Information Advise the patient to read the FDA-approved patient labeling ( Medication Guide ) that accompanies each prescription dispensed. In the setting of coronary artery bypass graft (cabg) surgery see warnings AND precautions. Celecoxib Long-Term Arthritis Safety Study (class) This was a prospective, long-term, safety outcome study conducted post-marketing in approximately 5,800 OA patients and 2,200 RA patients. Monitor serum digoxin levels. Talk to your healthcare provider before using overthe-counter nsaids for more than 10 days. How dosage long to take it Depending on your condition, you may need Celebrex for a few days or for longer periods. If you are allergic to aspirin, nsaids, or other Coxib medicines and take Celebrex, these symptoms may be severe. Pharmacodynamics Platelets In clinical trials using normal volunteers, celebrex at single doses up to 800 mg and multiple doses of 600 mg twice daily for up to 7 days duration (higher than recommended therapeutic doses) had no effect on reduction. Status Post Coronary Artery Bypass Graft (cabg) Surgery Two large, controlled clinical trials of a COX-2 selective nsaid for the treatment of pain in the first 10-14 days following cabg surgery found an increased incidence of myocardial infarction and stroke. Symptoms of an allergic reaction to these medicines may include: asthma, wheezing or shortness of breath swelling of the face, lips or tongue celebrex which may cause difficulty in swallowing or breathing hives, itching or skin rash fainting. The estimated cumulative rates at 9 months of complicated and symptomatic ulcers for patients treated with celebrex 400 mg twice daily are described in Table. There have been no large, clinical outcome studies to compare clinically relevant GI outcomes with celebrex and naproxen. Celebrex and other nsaids may cause ulcers, stomach perforations, and sudden bleeding in your stomach or intestine. You also may not be able to take Celebrex if you've ever had hives or asthma after taking aspirin or another nsaid. Contraindications celebrex celebrex is contraindicated in the following patients: Known hypersensitivity (e.g., anaphylactic reactions and serious skin reactions) to celecoxib, any components of the drug product see warnings AND precautions. If you do not understand the instructions on the label, ask your doctor or pharmacist for help. Instruct patients to seek immediate emergency help if these occur see contraindications and warnings AND precautions. Pre-marketing Controlled Arthritis Trials Table 1 lists all adverse events, regardless of causality, occurring in 2 of patients receiving celebrex from 12 controlled studies conducted in patients with OA or RA that included a placebo and/or a positive control group.
The mean duration of effect as measured by a 15 increase celebrex in FEV1 was 3 hours. # I have experienced. Treatment for a Retinal Tear. 5 This drug is available at a higher level co-pay. Pdms, if used, needs to be removed after a period of 28 months depending on what surgeon's preference. Code Definition PA Prior Authorization Drugs that require prior authorization. Values are mean (SD). No other difference in the rate of adverse events (other than bleeding) was reported. These are similar celebrex to effects celebrex produced by the structurally related chlorofluorocarbons (CFCs which have been used what extensively in metered dose celebrex inhalers. Heparin : in a clinical study conducted in healthy subjects, clopidogrel did not necessitate modification of the heparin dose or alter the effect of heparin on coagulation. Albuterol has been shown in most clinical trials to have more effect on the respiratory tract, in the form of bronchial smooth muscle relaxation, than isoproterenol at comparable doses while producing fewer cardiovascular effects. In addition, IPA was 32 (24 hours) and 61 (Day 5 which were greater than in the poor metabolisers receiving the 300 mg/75 mg regimen, and were similar to the other CYP2C19 metaboliser groups receiving the 300 mg/75 mg regimen. Information published on this website is not intended to replace, supplant, or augment a consultation what with celebrex an eye care what professional regarding the viewer/user's own medical care. The medication also has some effects on decreasing the activity of mast cells in the lungs, which play an important role in inflammation and allergic reactions). Many doctors may choose to add an aspirin per day along with the Plavix dose in both non-ST elevation and ST elevation MIs as well as to stroke and peripheral vascular disease patients. Do not puncture or burn the canister. Binge Eating Disorder Compulsive overeating is eating more than needed. Prevention of atherothrombotic and thromboembolic events in atrial fibrillation. Tocolysis: Albuterol has not been approved for the management celebrex of preterm labor. Doxycycline is partially celebrex synthetic. The CYP2C19*1 allele corresponds to fully functional metabolism while the CYP2C19*2 and CYP2C19*3 alleles are nonfunctional. In patients who were enrolled in the trial on the sole basis of a recent myocardial infarction, clopidogrel was numerically inferior, but not statistically different from ASA (RRR -4.0; CI: -126.96.36.1999). If the mouthpiece becomes blocked, washing the mouthpiece will remove the blockage. Its still important to know the symptoms because a serious rash from Lamictal can be fatal. Table 1: cure Incidence of Bleeding Complications ( patients) Event Plavix ( aspirin) (n6259) Placebo ( aspirin) (n6303) Major bleeding.7.7 Life-threatening bleeding.2.8 Fatal.2.2 5 g/dL celebrex hemoglobin what drop.9.9 Requiring surgical intervention.7.7 Hemorrhagic. Symptoms, celebrex a patient with an acute retinal tear may experience the sudden onset of black spots or floaters in the affected eye. It carries a black-box warning from the United States (U.S.) Food and Drug Administration (FDA) for liver function. While you are taking proventil HFA, other inhaled drugs and asthma medications should be taken only as directed by your physician. Before you use Proventil HFA for the first time make sure that the pointer on the dose indicator is pointing to the right of the 200 inhalation mark in the dose indicator display window (See Figure A ). In contrast, post-hoc analyses demonstrated statistically significant increases in the bleeding risk with the more potent P2Y12 what inhibitors, occurring predominantly during the maintenance phase, after the first month post-ACS. Serious adverse reactions, including pulmonary edema, have been reported during or following treatment of premature labor with beta2-agonists, including albuterol. Postmarketing Experience The following adverse reactions have been identified during postapproval what use of Plavix. Sudden decrease of vision, detection and Diagnosis, retinal detachments are usually found because the patient calls the doctor's office with a symptom listed above.
At steady state, the generic average inhibition level observed with a dose of celebrex 75 mg per celebrex day was between 40 and. It is just how our bodies work! 1 2, this may be described as a curtain over part of the field of vision. Treatment and generic prognosis, if a retinal tear is diagnosed promptly before it progresses to retinal detachment, celebrex the prognosis is extremely good. Complications from eye surgery can cause retinal tears. A b Haug SJ, Bhisitkul RB (2012). If it makes your pet have breathing or swallowing problems, follow tablet with a small amount of water. "The epidemiology generic of rhegmatogenous retinal detachment: geographical variation and clinical associations". Doxycycline generic for dogs may be the best choice if your pet has been diagnosed with an infection, but you should never use an old prescription to treat new symptoms. 38 Tractional retinal detachments can also occur in patients with proliferative diabetic retinopathy 39 or those with proliferative retinopathy of sickle celebrex cell disease. The third type happens when fluid collects underneath the layers of the retina, causing it to separate from the back wall of the eye. Table 4: Outcome Events in the cure Primary Analysis Outcome Plavix generic ( celebrex aspirin (n6259) Placebo ( aspirin (n6303) Relative Risk Reduction (95 CI) Primary outcome ( Cardiovascular death, MI, stroke) 582 (9.3) 719 (11.4) 20 (10.3,.9).001. Plavix is used to lower your risk of having a stroke, blood clot, or serious heart problem after you've had a heart attack, severe chest pain ( angina celebrex or circulation problems. Your eye surgeon uses a special freezing probe celebrex to apply intense cold and freeze the retina around the retinal tear. Patients who are homozygous for nonfunctional alleles of the CYP2C19 gene are termed CYP2C19 poor metabolizers. Stopping clopidogrel may increase your risk of a heart attack or stroke. Clinical Studies Acute Coronary Syndrome cure The cure study included 12,562 patients with ACS without ST-elevation (UA or nstemi) and presenting within 24 hours of onset of the most recent episode of chest pain or symptoms consistent with ischemia. Provided with gas masks to counter the effect s o f tear g. This is known as a posterior vitreous detachment (PVD). Consequently, a direct effect (slight toxicity or an indirect celebrex effect (low palatability) cannot be excluded. Therefore, concomitant use should be undertaken with caution (see section.4). Journal of Clinical Microbiology. I'd rather have fewer days but better days than more days in the fog I lived. The mean chads2 score was.0 (range 0-6). Proton Pump Inhibitors (PPI Omeprazole 80 mg once daily administered either at the same time as clopidogrel or with 12 hours between the administrations of the two drugs decreased the exposure of the active metabolite generic generic by 45 (loading dose) and 40 (maintenance dose). Rowe JA, Erie JC, Baratz KH, Hodge DO, Gray DT, Butterfield L, Robertson DM (1999). You may report side effects to FDA at 1-800-FDA-1088. The dosage may need to be adjusted if your pet has certain other medical conditions or takes generic certain medications. I do watch it via microsope. Symptoms of a Retinal Tear? Approximately 88 of patients received concomitant ASA (range of 1 to 23 mg/kg/day). How does Doxycycline for Dogs Work? "Diabetic Retinopathy: Retinal Disorders: Merck Manual Home Health Handbook". Plavix can increase the systemic exposure to drugs that are primarily cleared by CYP2C8, thereby needing dose adjustment and appropriate monitoring. Ultrasound of the Week. It starts when plaque, a substance made of hard cholesterol, collects within a coronary artery. The empirical formula of clopidogrel bisulfate is C16H16ClNO2SH2SO4 and its molecular weight is 419.9. Other concomitant therapy : generic Since clopidogrel is metabolised to its active metabolite generic partly by CYP2C19, use of medicinal products that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel.
I was working as an ER nurse, and life was going quite smoothly for me and my family. One morning, as I was getting out of bed, my hand happened to brush against an unfamiliar lump on the side of my left leg, just 4 inches above the knee. It was painless, about half the size of a Silly Putty egg, and was easy to wiggle around. It seemed to have come out of nowhere.
Alarmed, I called my doctor and got in to her office that morning to get it checked out. She examined it, and said, “It looks like a lipoma to me.” She explained that lipomas are benign lumps of fat tissue, and that no treatment is usually indicated. Still, she instructed, if the lump got bigger or became uncomfortable, she wanted to know about it.
Several months went by. The lump sometimes seemed to be a little bigger; I couldn’t really tell. It also seemed to be more anchored down into the muscle. Then it began to get uncomfortable, especially when I was on my feet at work. Tylenol helped, but I decided to get it checked out again as I’d been instructed. I will never forget the look of alarm on my doctor’s face when she rechecked the lump. Immediately she gave me the name of a surgeon, and instructed me to follow up with her that day.
The surgeon was very nice. If she suspected the lump was anything other than a lipoma, she didn’t let on at that first meeting. I was scheduled to travel to France on vacation the following month; she suggested that I could wait until after my trip to schedule the surgery if I wished. But, since the lump was causing some discomfort and I planned to do a lot of walking on my trip, I asked, “Could I just get it done right away?” She said, “Of course. Next Monday morning, if you like.”
I arranged to have four days off from work (that should be plenty, right?) and Monday morning found me and my husband sitting in a pre-surgical room, an IV in my arm, awaiting the excision of what was termed a “mass” on my left leg. I don’t remember the surgery, of course, since I was under anesthesia. But I do remember waking up, and being somewhat groggy as someone handed me a glass of ginger ale and encouraged me to drink it. I remember, too, hearing my surgeon talking to my husband. She said something like, “Lipoma tissue is easy to recognize, just as fat is easy to recognize on a piece of meat. What I found didn’t look like a lipoma. So I did a biopsy instead of removing it, and sent it to pathology right away.” And I heard, with dismay, the word “sarcoma.”
I remember lying there, still feeling foggy, sipping at that ginger ale (they told me I couldn’t go home until they were sure I could take fluids). I also remember feeling a tear going down my face that I hadn’t even realized was there. I saw tears in my surgeon’s eyes, too. I said, “Do I have to cancel my trip?” She said very quietly, “I think it would probably be wise.” Because sarcomas can be tricky, my surgeon told me, she couldn’t remove it herself. She referred me to a colleague of hers who specialized in surgical oncology at Loyola University Medical Center. “You must get in there before next Tuesday,” she said. “If they can’t fit you in before then, call me back, and I will see that they get you in.” Dazed, I made the appointment.
This surgeon, too, proved to be very nice, as well as encouraging. He showed me how he would make a D shaped incision, right over the biopsy incision, and remove the tumor as well as a thick layer of tissue all around it. “You’ll have a crater in your leg,” he warned me. “Then you will have radiation therapy for several weeks, and then you’re done.” Radiation? The word scared me. I’d taken care of cancer patients undergoing radiation before. It suddenly dawned on me: I am a cancer patient.
The surgeon sent me to another building to meet with a radiation oncologist. This doctor was quite humorous, which I found reassuring. He said to me, “So, you were just going along minding your own business, and then one day…?” I told the story all over again for him, and he, his nurse and the resident working with him all examined the lump on my leg. Surgery was scheduled for September 28, less than three weeks after the biopsy: it was termed “radical excision of sarcoma, left leg.” I would also be given brachytherapy, a form of radiation I’d never heard of. The oncologist said, “You’re lucky. Twenty years ago, the treatment of choice would have been amputation.”
When I’d first emerged from the anesthesia after my biopsy and heard my surgeon utter the word “sarcoma,” I couldn’t think of anything else. One of the things that I’d shoved to the back of my mind was a visual problem that had cropped up, for some unknown reason, while I was lying in the pre-op waiting room. I’d started to see double. This wasn’t the first time I’d experienced this: it was a fairly common temporary occurrence for me after a migraine. Only, this time, it didn’t go away. On top of that, I was experiencing some serious pain issues. Apparently the tumor had been slightly pressing on a nerve (causing the discomfort at work). After the biopsy, the tissues were swollen, resulting in excruciating pain in the upper leg. Two pillows under the leg, an ice pack and the maximum amount of Norco did almost nothing for it. I called my surgeon, and she ordered a stronger narcotic pain medication. It helped, but made me dizzy. But I had no choice but to use it. At the same time, I started having night sweats and nausea. I remember thinking that it was almost like a migraine, except that my head didn’t hurt and it lasted much longer than any migraine I’d ever had. All of this as a result of a simple biopsy?? I couldn’t believe how sick I was! My unit manager at work, bless her, immediately got to work filing papers for short term disability. She didn’t even ask me how long I thought I’d be out, which is good because I had no idea. To tell you the truth, I was so frightened and so sick and in so much pain I wondered if I’d even survive this thing.
The sarcoma surgeon was very concerned when the double vision didn’t clear up. In the bald way that doctors tend to talk to nurses, he said to me, “I don’t want you to stroke out on the table during surgery.” So it was decided that the low beam radiation would be done before, instead of after, surgery. Meanwhile, I could see an ophthalmologist about my eyes. Accordingly, I spent a day at the hospital undergoing an MRI of the leg and a CAT scan of the chest, then being set up for radiation treatments.
A radiation technologist put three little tattoo marks on my pelvic area that felt like tacks were being hammered into me. Then a big blue plastic form was placed under my legs, and swelled up to create a mold, into which my legs would be placed during radiation sessions, to ensure accurate positioning. The following Monday I had my first treatment. I was instructed to put on a blue hospital gown, and told to climb up onto a table with a big machine over it, vaguely resembling an X-ray machine. The blue leg mold was already in place for me to put my legs into. Two radiation technologists meticulously adjusted my position until it was exactly to their liking. Then they slammed a big cartridge into the machine, and left the room.
The machine whirred along on an axis, until its head was pointing under the side of my left knee. A thin buzzing noise—I counted seventeen seconds until it stopped. Then the door opened again, the technologist made some more adjustments and placed another cartridge into the machine, and the whole process was repeated, for about eleven seconds this time. The third time lasted only five or six seconds. The technologist came back in the room, helped me off the table, and assisted me into the dressing room.
That was it? Somehow, I’d expected radiation treatment to last forty minutes or so. But, less than ten minutes after I’d been called back, I was getting dressed to go home. That was the routine for the next five or six weeks, Monday through Friday, every day at 9:30 am. It wasn’t easy. My nausea and pain continued for weeks. I lost 10 pounds, which would have pleased me at any other time, but I found that the doctor and nurse were very concerned about it. I also found that, if I stood on my left leg for more than about three seconds, I’d get a severe cramp like a charley horse. I couldn’t eat. I couldn’t sleep. I would take the pain pills (which had a Tylenol base), and then wake up at 3 am, drenched with sweat from the low grade fever which had broken.
To this day, I have no idea what caused the fever or the nausea. The doctor told me to drink Ensure or Boost to keep up my caloric intake. The nurse lectured me about not eating. How could I make her understand how the very idea of food revolted me? It was, I thought, as if someone had handed me a big spoonful of dirty litter out of my cats’ litter box, and said, “You have to eat this to get better.” She said, “Every bite you get in is a battle won. If you can’t eat a meal, then eat a bite. Then eat another bite. You MUST keep up your strength for surgery.”
At my very lowest point, I remember lying alone in bed (my husband was sleeping in another room, to give me more room to spread out) reciting the 23rd psalm over and over to myself. Getting up to the bathroom was difficult, sometimes impossible, without help, due to the pain and dizziness. I’d wake up at 5 each morning, and try to delay getting up for as long as possible; washing and dressing myself was exhausting. At 7:20, my college student nephew, who had no early classes, would arrive to drive me the 30 miles to radiation.
But then something happened. During the last two weeks, the pain suddenly started to get better. I started to have a little more appetite, too, and the food I ate stayed down. I was drinking a can of Boost (the smell of that drink will forever remind me of sarcomas and double vision!) each morning, and even eating some lunch and dinner. The dizziness was still there, but not as bad.
On my last day of radiation, the day before my birthday, the radiation tech said, “Congratulations: you’ve graduated!” and hugged me. The blue mold for my legs was torn into pieces and discarded. And – miraculous to me! – the tumor was now completely painless, and even felt smaller. But there was still the problem of the double vision. After a temporal artery biopsy, which proved to be negative, the ophthalmologist sent me to a neuro-opthalmologist, who sent me to a neurologist. None of them figured out what was triggering the problem, but I was cleared for surgery. Thank goodness!
On January 18, while it was still dark out, my husband and I climbed the steps up to the hospital entrance. I was wearing a new blue dress, a Christmas present from my husband, since I had nothing else to wear that would go over the knee immobilizer and dressing I’d have after the surgery. I thought ruefully of my “skinny” jeans at home. After this, I’ll have to wear baggy pants, I thought, because of the crater in my leg. I’ll never wear skinny jeans again. The anesthesiologist checked me out, pronounced my jaws and neck and throat to be a “textbook example,” which made me quite pleased, and the nurse came in and inserted an IV into the back of each of my hands.
I remember lying on the cart waiting for something to happen, and, the next thing I knew, it was late afternoon, I was vomiting into a small basin, and somebody was telling me, “Your surgery is over.” I was relieved to discover that I was still alive, and that I still had two legs. Despite the surgeon’s assurance that I’d be fine, somehow I’d expected I wouldn’t be. That probably comes from working in the ER, where everyone assumes the worst until proven otherwise. I had a big knee immobilizer on my left leg, and a local anesthetic being administered by a pain pump. It worked pretty well.
The next morning, I had a migraine, most likely, I think, because I’d gone for some 30 hours without eating, other than a clear liquid dinner after surgery. Unfortunately, even a migraine can’t be permitted to get in the way of preparations for brachytherapy. Two EMTs took me by cart down to an ambulance, and drove me to the radiation oncology department (in another building), where I was met by my radiation oncologist, a physicist, and a radiation technologist. While I lay with a towel on my aching head and tried not to throw up, they removed the knee immobilizer, exposing nine catheters that had been inserted into my leg during surgery, and did some adjustments to prepare for brachytherapy the following Monday. I was too sick to pay much attention, but was dimly aware that preparations took at least a couple of hours. Two and a half days after the surgery, I went home, with the knee immobilizer and a bulb shaped Jackson Pratt drain, which I was instructed to empty every eight hours and record the amount of fluid discarded.
The following Monday, I was back for brachytherapy. This consisted of lying on an uncomfortable table trying not to move, with a bunch of narrow tubes connected to the catheters in my leg. I was alone in the room; every so often the radiation machine would make a grumbling noise. These sessions lasted for about 20-30 minutes, as I remember; there were two a day for two days. Then the catheters were removed (ow!). The radiation oncologist told me that I could now bend my leg, although the surgical drain still made bending or weight bearing somewhat uncomfortable. Two weeks after surgery, I saw the surgeon in his office, and he removed the drain (ow!!!!) I was surprised how much less discomfort I had, once all the hardware was out of the incision.
Well, it’s been almost ten months since my surgery, and my birthday is almost here again. I went back to work about six weeks after my surgery, to assume a full work load. I haven’t missed a day of work since then. I didn’t need any special therapy after surgery, and stopped taking pain pills long before I’d run out of my initial prescriptions. (One thing about oncologists: they’re VERY generous with pain medication.) I had underestimated how uncomfortable it is to have a drain in your leg. Once it was out, I felt much better, and much more able to move around and do ordinary tasks.
The night sweats and nausea never came back. I have no idea, to this day, what caused them, nor does my radiation oncologist. I’m just glad they’re gone. The crater shaped incision filled out quite a bit after surgery, and now looks fairly normal if you don’t look too close. And, yes, I’m still wearing my “skinny” jeans. I’m rubbing moisturizer on the surgical site every day, as I will have to do forever, since the sweat glands were destroyed by radiation, and the skin must be protected from cracking.
The surgeon told me that the surgical pathology report showed that the tumor was dead. I’ve gone back about every three months for an MRI of the upper leg, and a CAT scan of the chest. The radiation oncologist carefully examines the CAT scan for any sign of nodules, which would indicate metastasis. So far, so good.
Life is pretty much back to normal for me now, but, of course, not a day goes by that I don’t realize what I’ve been through, and what still could be ahead of me if it turns out that the sarcoma wasn’t completely destroyed. I’ve learned since then that my sarcoma was rated as high grade–more prone to metastasize—and was larger (although not by much) than 5 cm in diameter. So for the rest of my life I’ll be a bit nervous every time I get a follow-up scan. Sarcomas aren’t respecters of that five-year rule, so there will be no time in my life that I can say with any certainty, “I’m cured!”
My experience made me more sensitive to the oncology patients we see in the ER. When appropriate, I will sometimes tell them I’m a sarcoma survivor, and I find that that knowledge makes them a little more comfortable in my care. They know, I guess, that I understand something of what they’re going through. And I learn from them, too, since I’m always aware that someday it could be me again, lying on that bed getting treated, rather than being the nurse doing the treating.
By the way, I did get to France, the following September. When I was working on trip arrangements, I confided to my husband, “Remember when we were going up those steps into the hospital before my surgery? I didn’t tell you this at the time, and it seems silly now, but when I swung open that door I was wondering if I’d ever come out again.” And he said to me, “So was I.”
I’m just glad for every healthy day I have, and I hope – and expect – there will be many more.
I would urge new patients to make a note of any questions and concerns, and talk them over with your doctor, because your imagination can run away with you when you get a scary diagnosis like this.