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  • Vacation soon after starting meds?

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    Old 03-05-2019, 11:05 AM   #1
    MrSunshine
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    Vacation soon after starting meds?

    Wife and I are considering vacation (Hawaii) mid-April. This is early March and I'm starting multiple strong medications, so we aren't sure if I'll be feeling like plane ride, hotel etc. Would appreciate advice from others who have been through similar experience.

    Meds: Casodex already started. First Lupron injection in about a week. First Xgeva injection at same time. Also start Zytega + Prednisone at same time.

    Situation summary: 76 YO. Stage 4 PC. Gleason = 8 for two of 12 samples. PSA = 111. One bone met, but no pain or other substantial symptoms yet.

    So: Go forward with or delay vacation plans?

    Last edited by MrSunshine; 03-05-2019 at 11:06 AM.

     
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    Old 03-08-2019, 12:45 PM   #2
    IADT3since2000
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    Re: Vacation soon after starting meds?

    Hi again,


    I have had personal experience starting Casodex and Lupron several times (the first round plus two subsequent rounds after vacation from therapy periods for both drugs). A very lucky small percentage of patients experience no adverse side effects on these drugs but still get the benefits. I once heard an estimate of 10% for these lucky patients from an expert medical oncologist with many patients on androgen deprivation therapy in his practice. Unfortunately, the flip side of that number means that roughly 90% of patients on ADT will experience some side effects. I did.

    Casodex, in combination with Lupron, usually adds little to the side effect profile. The main possibly noticeable impact might be on growth of or tenderness of breast tissue, but that is likely to be quite limited when Lupron is taken in combination and not a concern for a vacation.

    Lupron has a number of fairly likely side effects, with the most noticeable and bothersome, from a vacation standpoint, being hot flashes/sweats and possible joint or muscle soreness. There are good countermeasures that often help considerably with both, as described in several books and elsewhere. For hot flashes/sweats, one simple measure I found effective was keeping a fan handy both day and night and aiming at the bare neck area when sensing an oncoming flash/sweat or when in the midst of the flash/sweat. I used hand fans, car fans, desk fans, and standup fans, the latter especially at night. I also started on soy supplements early, the kind women take for hot flashes. Some patients have really strong flashes and sweats, and there are shots and medication that can relieve or even eliminate them for such patients. You should know about how you will do well before you start your trip.

    My joint and muscle pain from Lupron was certainly noticeable, in fact irritating, but not that much of a burden, and, without checking my records, I donít believe I took aspirin or another NSAID to get relief. Some patients experience a lot more intense soreness, and an NSAID would probably work.

    Zytiga/Prenisone is a more potent form of roughly Lupron-like ADT, and the combination with Lupron may increase the common side effects. In addition, some patients experience fatigue when on Zytiga. The US Food and Drug Administration posts prescribing information for Zytiga at https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/202379s024lbl.pdf. If you go to Section 6.1, you can see the table of side effects from the clinical trial; you can compare the side effects for Zytiga/prednisone with those for placebo to see where taking the drug really added to what the patient would have experienced if not taking the drug. Grade 1 and 2 side effects are fairly mild; Grade 3 and 4 side effects cause considerably more burden for the patient.

    Unfortunately, these figures donít show side effects for a combination with Lupron, though my laymanís impression is that the two are often given in combination these days.

    Xgeva (denosumab) is for preserving bone mineral density while on ADT. I have not been on that drug, and I hope someone else will respond.

    Good luck!

     
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    Old 03-14-2019, 04:10 AM   #3
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    Re: Vacation soon after starting meds?

    Another Thought - Thinking About The Trees or the Whole Forest - Travel and Side Effects

    My previous answer was more about the trees than about viewing the whole forest. Taking the broad view, I'm thinking its likely you will have some discomfort and irritation from these drugs, but nothing like a show-stopper. In contrast, recovery after radiation or surgery often does take some time (though kinds of radiation and surgery, side effects, and individual patient responses vary). I had 39 sessions of IMRT radiation that included a pelvic dose, and I did not want to be far from a bathroom for weeks afterward. A plane trip, with its long lines before boarding, confined spaces, and waits for bathrooms would not have been tolerable.

     
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