After Effects of CODOX-M/IVAC Plus Rituxan

I am taking one more break from animal related topics to help people who are recovering from the CODOX-M/IVAC plus Rituxan protocol (Modified MaGrath).  As a patient, I was frustrated by the lack of information regarding this protocol.  I didn’t know what to expect.  This post will cover what I experienced the year after finishing chemo.   Please remember, every person will react differently.  Just because I experienced it, does not mean you will. 

1) The First Six Weeks:  It took two weeks for my bone marrow to kick in after the last chemo treatment.  I finished chemo on December 6th and had my last transfusion on December 24th, 2010.  Thank you again to everyone who donates blood.  You saved my life!  Once I was done with blood and platelet transfusions, my strength improved and the nausea disappeared.  Although I was still weak and needed to sleep a lot, I felt so much better.  My appetite returned although I had to eat small portions.  Against my oncologist’s advice, I made plans to return to work in February part time.  Little did I know, what was to come. 

2) Neuropathy of Feet:  In February, my feet started to tingle.  The tingling progressed until I felt sharp pain with every step.  I put cushions in my shoes which helped a little.  Eventually, I bought a new pair of New Balance running shoes.  The cushion built into these shoes made the pain tolerable.  The discomfort peaked at the end of February and then slowly diminished until it was gone by April.

3) Abdominal Pain:  In mid-February, the pain returned in my abdomen.  It started small with slight discomfort in the evening and progressed.  By late March, the pain was overwhelming.  I was back in the hospital for diagnostics but the cause was never identified.  I think I had neuropathy in my intestines that disrupted the flow of ingesta through my body.  The pain slowly diminished and was gone by the end of June.

4) Fatigue:  I greatly underestimated how tired I would be after the CODOX-M/IVAC or Modified MaGrath protocol.  For months, I napped in the morning and afternoon when not working.  Even with those naps, I was exhausted by 7 pm.  By April, I was only taking a two hour nap in the afternoon.  My energy was improving until Arizona summer hit.  The extreme heat really wiped me out.  I felt like I took two steps backward in my recovery.  I began to worry about recurrence until I spoke with a wonderful chemo nurse named Debbie.  She told me that was normal and I would feel better when the temperatures broke.  Thank goodness, she was right.  Thank you Debbie for your care and support throughout this journey.  You are an awesome nurse! 

I am a year out now and my naps only last for thirty minutes.  My energy isn’t quite back to normal but it is much, much better. On days when I can’t nap, I need to go to bed early.  Debbie told me that rest is the key to recovery from chemo.  My personal experience backs up her statement.  Give your body time to rest.  It has been through a lot and needs time to recover. 

5) Hair:  When my hair was gone, my husband said “Don’t worry, I’m suddenly into bald chicks!”  I highly doubt it. He seemed particularly excited when my hair started to grow back at the end of January.  The first growth was a few course pieces of hair that felt like whiskers.  It hurt to put my head on a pillow.  Thank goodness, all of that fell out in about two weeks.  By the end of February, a shadow of gray and black hair covered my entire scalp.  By May, I had an inch of curly hair.  Faint traces of brown appeared in July.  A year later, my hair is still full of curls.  Since I had straight hair before, I am enjoying the new look.  They told me hair grows about 1/2 inch per month and that seems about how it went for me.  

6) Skin:  My skin, especially on my feet, was what I would term ‘fragile’ for months after chemo.  Shoes that normally felt great would cause blisters after an hour of wear.  Be particularly careful of heals.  I had to give an hour and one-half speech at a convention in March and thought my feet would be mush when I took off those shoes.  Heals three months after chemo were a very bad idea. 

7) Chemo Brain:  For many months after chemo, I felt like my brain was in a fog.  My memory wasn’t normal and I seemed to process information more slowly.  One year later, my memory has returned and I am thinking quickly again.  However, I still use the ‘chemo brain’ excuse when it’s helpful:) 

In closing, I would like to emphasize the importance of rest in the process of recovery.  After I finished chemo, my oncologist wanted me to take three to six months off before returning to work.  In retrospect, he was correct.  I could not have handled a full time schedule for at least six months.  Working part time was perfect for me during those early months because it gave me a chance to do what I like best . . . interacting with animals.  For me, it was the perfect therapy and way to celebrate life.  But, it took a toll as well.  

I sincerely hope these two posts are helpful.  You can beat cancer!  Keep the faith, be kind to your caregivers and embrace animals throughout the journey!


Published by kristennelsondvm

Dr. Kristen Nelson grew up on a farm in Watertown, Minn., where she developed a deep love for animals of all kinds. She received a Doctor of Veterinary Medicine degree from the University of Minnesota, College of Veterinary Medicine. Kris then completed a small-animal internship at the prestigious Animal Medical Center in New York City. In addition to writing and speaking, she cares for small and exotic animals in Scottsdale, Az. Dr. Nelson is widely quoted in the media. Her credits include Ladies’ Home Journal, USA TODAY, the Los Angeles Times and numerous radio and television interviews. Dr. Nelson has written two books, Coated With Fur: A Vet’s Life and Coated With Fur: A Blind Cat’s Love. Kris and her husband Steve share their home with rescued cats, birds and a dog.

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