HS1STINGRAY

I AM TAKING CARE FOR A LADY PATIENT, 55 YRS.OLD, DIAGNOSED OF LUNG CA. METS TO
SPINE AND NOW TO BRAIN - STAGE 4. RECIVING 27 TIMES OF RADIATON OF Co-60 AND JUST
FINISHED THE 4th CHEMO. - 7DAYS AGO. THE MED. RECEIVED AS FAR AS I KNOW ARE - -    
CARBOPLATIN & VEPESID -DOSE N/A. SHE , NOW, FEELS OF THE PAIN AT THE HIND-NECK, WAIST AREA NEAR THE SPINAL CORD. HER PAIN IS MORE SERIOUS EACH TIME AT THE INTERVAL OF AROUND 2 HOURS. SHE ROUTINELY GETS 20 mg. OF MORPHINE AT 09:00 a.m. AND 09:00 p.m. EVERYDAY; BUT IT SEEMS TO ME THIS IS NOT ENOUGH.                                
PLEASE KINDLY GIVE ME ADVICES AND/OR ANY RECOMMENDATION OF WHAT I SHOULD DO SO THAT I COULD HELP HER BETTER. tHANKS IN ADVANCE.

[HeinrikMD]

Hi,
Try to  find out if the areas of pain  were included during the treatment with radiation -  if they were not - then it may possible that these are new areas of metastasis and she could benefit from radiation over these areas. If they were included and the radiation was completed not more than  2 months ago - it is still possible  that she will  still get some improvement with the previous radiation.

try to find out if specific situations such as certain movements trigger the pain and hence anticipatory care may be delivered such as assistance with movement  or transfers  if the pain occurs at this time... you could also  discuss with her doctor if there may be room for pain medications involving nerve pain.

[HS1STINGRAY]

Thanks for your kind advice. I forgot to inform about her last radiation was on 12/26/07;
her Haemat. Analysis ( on 01/15/08 ) WBC was only 3,600 Cells/Cumm.; RBC 3,500,000;Hb 11.5 gm%; Hct 34.9%;MCV 99.8 fl.;Neutrophil 82; Lymphocyte 73; Monocyte 3; Eosinophil 2 % and Platelet smear:- adequate. Last Chemo. on 01/16 &17/08. She is awaiting for the next Chemo. on 02/16 & 17/08 (her 5th one) ( her doctor
planned to give her 6 chemos ). I 'll try to notice according to your comment and back to
this discussion board again. I DOUBT WHETHER SHE SHOULD RECEIVE THE NEXT AND THE REST OF CHEMOs. OR NOT !!!                                                    
Awaiting for your further kind advice. Again thanks in advance.// hs1stingray.

[HeinrikMD]

Hi,

I understand your concerns. One of the difficulties with treatment with chemotherapy is that not all patients exhibit early responses, so at times it is  difficult to make a decision whether it should be continued or not. Since she has completed 4 already, a guide would be the experience with those 4 cycles, to gauge  if there was any improvement or not.

If you are concerned with the blood test results, the blood is almost always involved during chemotherapy and recovery back to the normal values is not really expected and  not really required before the subsequent treatment. There is only a minimum safe value of the results ( based on the individual toxicity of whatever drugs are used in making the decision for continuity or not). You could inquire though about the use of r rescue medications (called colony stimulating factors) to reduce the side-effects on the blood.  

Keep an open mind and stay positive.

[HS1STINGRAY]

Thanks!! I thought WBC is playing part to consider of take or not take Chemo. To me, she is still O.K., only complained of pain at hind-neck, back part of shoulder - left & right, spinal cord around her waist - - I noticed at around 07:00 a.m. and 04:00 p.m. more often. I 'll speak with her physician about your rescue medications. I keep my fingers crossed for the positive response. Hope to hear from you again. Thank you in advance.  ( hs1stingray; 01/28/2008 - - 04:00 p.m. local time )

[HeinrikMD]

Hi,

The WBC will likely play a part in selecting what kind and what dosage would be used, the availability of rescue medications also plays a part.

In general everything would be considered - there are few absolute stopping rules in terms of at least considering treatment, as more treatment options continually evolve - I think a discussion at least of what can likely be gained with treatment or not should be presented to any interested patients.