Doctors differ on chemo delivery method

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DEAR DR. ROACH: My 70-year-old husband’s mantle cell lymphoma is being treated with chemotherapy, including doxorubicin, and he received his first cycle at MD Anderson, where they took 48 hours to infuse the doxorubicin chemo. When this cycle was repeated at our local hospital, they administered it as a push in just a few minutes. I am aware of the cardiac toxicity associated with this drug, and I questioned it being done in minutes rather than days. I had read that administering this slowly could reduce the toxicity, yet the doctor who ordered the push said it didn’t matter. I thought when we brought our regimen from MD Anderson it would be done exactly the same way. I am not finding that, and I am concerned. — L.S.

ANSWER: Doxorubicin (Adriamycin) is one of the most common and effective chemotherapy agents, especially in combination with other anticancer drugs. However, it needs to be dosed cautiously and skillfully, because there are several toxicities. The most important and dangerous is the cardiac toxicity. High doses for prolonged periods can permanently reduce the ability of the heart to squeeze. This is commonly reported as the “ejection fraction,” the proportion of blood emptied by the heart with each stroke. Normal values are typically about 50 to 75 percent.

Although the major predictor for doxorubicin toxicity is the total lifetime dose, there is some evidence that slower rates of infusion may reduce risk of developing cardiac toxicity. Also, local reactions, such as redness of the vein, as well as facial flushing, are more common if infused rapidly.

MD Anderson is one of the premier cancer hospitals in the U.S. (and the world). I would recommend speaking to your husband’s attending oncologist about the rate of infusion. Any reduction in this risk seems to me to be worth further discussion.

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DEAR DR. ROACH: With everyone drinking a lot of water during the summer, I noticed that the water depot where I fill up my gallon jugs supplies water in different ranges of alkalinity, from 8-10. This seems to be a new venture for the depot. The owner sells the alkaline water from inside the store and claims the benefit of this water is to neutralize the acidity of the many products we eat daily. He suggests that one might start by taking water with a pH of 8 or stronger, then dilute it to one’s requirements.

The purified water involves reverse osmosis so the company reintroduces calcium, magnesium and potassium to bring it up in value. Do you have any comments on alkaline water being consumed during this hot summer season? — B.A.

ANSWER: I recently have seen much confusion about acid and alkaline consumption. By adding a base to water, you raise the pH, making it more alkaline. You can do this at home simply by adding a bit of baking soda (sodium bicarbonate) to your water — you don’t need to buy alkaline water. Calcium carbonate is a common antacid. Calcium, magnesium and potassium are all elements we need, so in that respect, the alkaline water you are talking about is better than the sodium you would add to water with baking soda.

However, the important point is that under normal circumstances your body does not need any help in maintaining pH or in neutralizing acid. The body’s systems are able to maintain pH under almost any dietary condition. Alkaline water is not necessary for health.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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