advice for taking doxil while wearing lymphedema garments

[Linda12]

I have recurrent ovarian cancer and my doctor has prescribed Doxil.  In reading the information that the company has put out, they are quite insistent that one not wear tight fitting clothing.  However, I have lymphedema and must manage it with a tight fitting pressure garment worn 16 hours per day.  Has any one else out there take Doxil and managed lymphedema at the same time?  Is it possible?
Thank you and God Bless!
Linda

[Annekathryn Goodman, M.D.]

Hi There,
there are many options. Your gyn oncologist will be your best resource for what is appropriate. Major options include but are not limited to:

repeat use of platinum or taxol
gemzar
topotecan
cytoxan
hexamethylmelamine

take care

[Annekathryn Goodman, M.D.]

Dear Linda,
You ask a very good question! Doxil is a great drug for recurrent ovarian cancer. It does have one troblesome side-effect :palmar-plantar erythrodysesthesias or PPE. This means a painful rash on hands and feet.The skin gets red and peels This rash can also occur in creases in the body such as the waistline and the bra line. There does seem to be an increase in skin toxicity in areas of trauma, rubbing, and tight clothing. I have even seen the rash on the ears which I assume comes from pressure on the ears when a person is sleeping.

So I do worry that lymphedema garemtns may increase this side effect.  Several interventions seem to help including steroids, heavy use of ointments, and cooling.

You should talk with your doctor more about this. I hae personally given doxil to my patients who have lymphedema. They have developed PPE and we have done all sorts of things from reducing the dose, delaying therapy, and lots of creams and ointments.

I have pasted a nice summary below from:http://www.cancerlynx.com/doxil.html


October 2, 2000

Doxil Side Effects Relief - Do's and Don'ts
Information Sheet for the Prophylaxis and/or treatment of ppe and stomatitis
Christina Carr and Susan Temple, RN, MSN
In Memorium - Christina Carr, November 9, 2003

Cooling Procedures (Stomatitis and PPE)
B. Pyridoxine (Vitamin B6) for PPE
C. Topical DMSO for PPE
D. Other Topical Measures

A. Cooling Procedures (Stomatitis and PPE)
Back to the Table of Contents

In general, utilize cooling procedures during days 1-3 (minimum) of each cycle, continuing for up to 6 days.
    Apply ice packs to hands and feet (malleable gel ice packs or bags of frozen peas are recommended.) Alternate on and off for 15-20 minutes at a time.


    Sucking ice chips and/or Popsicles


    Refrain from eating or drinking any very warm/hot/spicy foods or liquids which includes hot tea, coffee, hot soups, etc.


    Stay in cool places (in shaded areas, air-conditioned rooms, etc.)


    Soak hands and/or feet in basins of cold water when possible (e.g. while watching television, reading or listening to the radio) for short periods of time.


    Take cool baths or stay in the pool during the summer. Avoid hot showers, hot tubs, hot baths for at least four days following your treatment.


    Keep hands and feet uncovered (no gloves, socks, etc.)


    Avoid all tape, tight fitting clothing and shoes (eg tight belt, jeans, etc.) Absolutely NO nylons!!! Wear very loose fitting (couple of sizes larger than you normally wear) sports bras. No elastic!!!


    Protect skin from the sunlight. Wear 15-30 sun screen or a long sleeve blouse. Stay in the shade.


    Avoid increased pressure on the soles of the feet or hands, for at least 5 days after treatment. NO - aerobics, power walking or jumping. Example: Do not have treatment and then go to Six Flags for the day!!!!


    Avoid vigorous activity (no digging, pruning or vigorous gardening).


    No chopping hard food by hand or using a garlic press. Do not use any sort of force or pressing motion (increased pressure on the palms of the hands).


    Do not lean on elbows or sit in a position that wodld create pressure.


    No activity that wodld cause friction such as sexual intercourse.

B. Pyridoxine (Vitamin B6) for PPE
Back to the Table of Contents

B6 is available over-the-counter in any health store or pharmacy. Take 50-150 mg/day beginning at the first signs of redness or tingling. Can also be taken prophylactically.

C. Topical DMSO for PPE
Back to the Table of Contents

Topical DMSO (99%) may be applied to affected areas at the first signs of redness or tingling and can be combined with the use of ice packs as listed in the cooling procedures.

D. Other Topical Measures
Back to the Table of Contents

Topical moisturizers or creams can be used. These shodld be applied carefdlly without unnecessary rubbing and can be used with the cooling procedures. Avoid lotions and creams with perfumes, alcohol or glycerin.
    1) Use creams only such as Euercin.


    2)Bathe in Aveeno (over-the-counter) bath treatments (tepid water temperature).


    3) Bag Balm (found in pet section of Walmart) has sdlfur which helps when fingers and toes are cracking at the joints.

    4) For mouth sores, have physician prepare the mouthwash that heals the sores. Miracle Mouthwash

kitten picture You are welcome to share this © article with friends, but do not forget to include the author name and web address. Permission needed to use articles on commercial and non commercial websites. Thank you.
Search Cancerlynx.com - We Prowl the NetTM

[Linda12]

I also am a college professor and with all of these interventions, I don't see a way that I can meet class and manage side effects that apparently *will* occur since I wear the compression garment.  What other drugs are good options?
Thank you!
Linda