Aa
Prognosis
Hello Dr. Im writing to you again regarding my Mom and what you think on her future prognosis. Not sure if you remember but my Mom was recently dx with right pleural effusion which was causing many problems with stomach pain and vomiting. Finally after several lung taps we had the chest tube done. She's been in the hospital and rehab for 5 weeks now and just today got home. First they did beside chest tube...didnt work. After she had the VATS procedure and thankfully its been 2 weeks and no fluid and no shortness of breath really. Only problem is very very severe swollen legs & thighs which is painful and makes it extremely hard to move around. She was at the rehab for 1.5 weeks, some improvement, 10lbs of water weight loss, but much more to go.
1st Q: what can she do, besides lasixs pills, to get rid of the fluid in her legs?
2nd Q: Is it anything cancer related that her legs and thighs are so swollen, or is just because of laying in the hospital for 4 weeks?
Her protein is very low, 7, and drinking boost drinks to help that.
3rd Q: Anything else you can recommend to bring up her protein levels.
At the rehab they were giving her all kinds of medication including many vitamins, potassium, pain medicine, and sometimes she still throws up...usually within half hour after receiving her morning meds including morphine sulfate 15 mg.
4th Q: Is it all the pills that could be causing the throwing up or is it cancer related?
She had 2 doxil treatments, her 3rd has been postponed twice since her nutrition level is so low and she is due for her next treatment in 1 week. We just received her recent ca-125 this morning and it went down 500 points from 880 to 380. We are super super happy, i cannot be any happier about this, so obviously showing that doxil is working for her.
5th Q: Can doxil bring her ca-125 to normal or CT scans to clear to give her a break for chemo for a while?
****please see the next post for continue*****
1st Q: what can she do, besides lasixs pills, to get rid of the fluid in her legs?
2nd Q: Is it anything cancer related that her legs and thighs are so swollen, or is just because of laying in the hospital for 4 weeks?
Her protein is very low, 7, and drinking boost drinks to help that.
3rd Q: Anything else you can recommend to bring up her protein levels.
At the rehab they were giving her all kinds of medication including many vitamins, potassium, pain medicine, and sometimes she still throws up...usually within half hour after receiving her morning meds including morphine sulfate 15 mg.
4th Q: Is it all the pills that could be causing the throwing up or is it cancer related?
She had 2 doxil treatments, her 3rd has been postponed twice since her nutrition level is so low and she is due for her next treatment in 1 week. We just received her recent ca-125 this morning and it went down 500 points from 880 to 380. We are super super happy, i cannot be any happier about this, so obviously showing that doxil is working for her.
5th Q: Can doxil bring her ca-125 to normal or CT scans to clear to give her a break for chemo for a while?
****please see the next post for continue*****
Thank You for the information. If possible, please let me know your thoughts on the remaining questions
with many Thank you's
Fiana
with many Thank you's
Fiana
MEDICAL PROFESSIONAL
Q 1 continued:
DIAGNOSING THE CAUSE OF EDEMA — If you develop new swelling in one or both of your legs, hands, in your abdomen, or around your eyes, you should be call your healthcare provider to determine if you need to be evaluated. (See "Clinical manifestations and diagnosis of edema in adults").
EDEMA TREATMENT — Treatment of edema includes several componenents: treatment of the underlying cause (if possible), reducing the amount of salt (sodium) in your diet, and in many cases, use of a medication, called a diuretic, to eliminate excess fluid. Compression stocking and elevating the legs may also be recommended. (See "General principles of the treatment of edema in adults").
Not all types of edema require treatment. Edema related to pregnancy or menstrual cycles is not usually treated. Peripheral edema and ascites is usually treated slowly to minimize the side effects of rapid fluid loss (such as low blood pressure).
Reduce salt (sodium) in your diet — Sodium, which is found in table salt, can worsen edema. Reducing the amount of salt you consume can help to reduce edema, especially if you also take a diuretic. Guidelines on how to reduce sodium are available separately. (See "Patient information: Low sodium diet").
Diuretics — Diuretics are a type of medication that causes the kidneys to excrete more water and sodium, which can reduce edema. Diuretics must be used with care because removing to much fluid too quickly can lower the blood pressure and impair kidney function.
You may have to empty your bladder more frequently for several hours after taking a loop diuretic. However, other side effects are uncommon when diuretics are taken at the recommended dose.
Compression stockings — Leg edema can be prevented and treated with the use of compression stockings. Stockings are available in several heights, including knee-high, thigh-high, and pantyhose. Knee-high stockings are sufficient for most patients. Some stockings can cause skin irritation or pain, although proper measurement and fitting of the stockings can reduce the risk of discomfort. More detailed compression stocking tips are available in table 2 (show table 2).
Effective compression stockings apply the greatest amount of pressure at the ankle and gradually decrease the pressure up the leg. These stockings are available with varying degrees of compression. Stockings with small amounts of compression can be purchased at pharmacies and surgical supply stores without a prescription. People with moderate to severe edema, those on their feet a lot, and those with ulcers usually require prescription stockings. A healthcare provider may take measurements for stockings, or may write a prescription for stockings and then have a surgical supply or specialty store take the necessary measurements. The white "antiembolism" stockings commonly given in the hospital do not apply enough pressure at the ankle and are not adequate treatment for edema.
Body positioning — Leg, ankle, and foot edema can be improved by elevating the legs above heart level for 30 minutes three or four times per day. Elevating the legs may be sufficient to reduce or eliminate edema for people with mild venous disease, but does not usually help in more severe cases. In addition, it may not be practical for those who work to elevate their legs several times per day.
DIAGNOSING THE CAUSE OF EDEMA — If you develop new swelling in one or both of your legs, hands, in your abdomen, or around your eyes, you should be call your healthcare provider to determine if you need to be evaluated. (See "Clinical manifestations and diagnosis of edema in adults").
EDEMA TREATMENT — Treatment of edema includes several componenents: treatment of the underlying cause (if possible), reducing the amount of salt (sodium) in your diet, and in many cases, use of a medication, called a diuretic, to eliminate excess fluid. Compression stocking and elevating the legs may also be recommended. (See "General principles of the treatment of edema in adults").
Not all types of edema require treatment. Edema related to pregnancy or menstrual cycles is not usually treated. Peripheral edema and ascites is usually treated slowly to minimize the side effects of rapid fluid loss (such as low blood pressure).
Reduce salt (sodium) in your diet — Sodium, which is found in table salt, can worsen edema. Reducing the amount of salt you consume can help to reduce edema, especially if you also take a diuretic. Guidelines on how to reduce sodium are available separately. (See "Patient information: Low sodium diet").
Diuretics — Diuretics are a type of medication that causes the kidneys to excrete more water and sodium, which can reduce edema. Diuretics must be used with care because removing to much fluid too quickly can lower the blood pressure and impair kidney function.
You may have to empty your bladder more frequently for several hours after taking a loop diuretic. However, other side effects are uncommon when diuretics are taken at the recommended dose.
Compression stockings — Leg edema can be prevented and treated with the use of compression stockings. Stockings are available in several heights, including knee-high, thigh-high, and pantyhose. Knee-high stockings are sufficient for most patients. Some stockings can cause skin irritation or pain, although proper measurement and fitting of the stockings can reduce the risk of discomfort. More detailed compression stocking tips are available in table 2 (show table 2).
Effective compression stockings apply the greatest amount of pressure at the ankle and gradually decrease the pressure up the leg. These stockings are available with varying degrees of compression. Stockings with small amounts of compression can be purchased at pharmacies and surgical supply stores without a prescription. People with moderate to severe edema, those on their feet a lot, and those with ulcers usually require prescription stockings. A healthcare provider may take measurements for stockings, or may write a prescription for stockings and then have a surgical supply or specialty store take the necessary measurements. The white "antiembolism" stockings commonly given in the hospital do not apply enough pressure at the ankle and are not adequate treatment for edema.
Body positioning — Leg, ankle, and foot edema can be improved by elevating the legs above heart level for 30 minutes three or four times per day. Elevating the legs may be sufficient to reduce or eliminate edema for people with mild venous disease, but does not usually help in more severe cases. In addition, it may not be practical for those who work to elevate their legs several times per day.
MEDICAL PROFESSIONAL
Hi Fiana,
thank you for the update. I will have to answer your questions as time and space permits . here is for Q 1
best wishes
1st Q: what can she do, besides lasix pills, to get rid of the fluid in her legs?
Fluid in the legs can be because of a low protein level. This is dues to malnutrition from being severely ill. The medical term for this is anasarca.
Here is a good patient education summary from UpToDate
Patient information: Edema (swelling)
Author
Burton D Rose, MD Section Editor
Robert H Fletcher, MD, MSc Deputy Editors
Leah K Moynihan, RNC, MSN
David M Rind, MD
Last literature review version 17.2: May 2009 | This topic last updated: May 8, 2009 (More)
EDEMA OVERVIEW — Edema is the medical term for swelling caused by a collection of fluid in the small spaces that surround the body tissues and organs. Edema can occur nearly anywhere in the body. Some of the most common sites are: The lower legs or hands (also called peripheral edema) Abdomen (also called ascites) Chest (called pulmonary edema if in the lungs and pleural effusion if in the space surrounding the lungs)
Ascites and peripheral edema can be uncomfortable, and can be a sign of a more serious condition. Pulmonary edema, which can be life-threatening, is a symptom of heart failure and is discussed in more detail separately. (See "Patient information: Heart failure causes, symptoms, and diagnosis").
EDEMA SYMPTOMS — Symptoms of edema depend upon the cause, but may include: Swelling or puffiness of the skin, causing it to appear stretched and shiny. This is typically seen in the lower legs (called peripheral edema) or lower back (called sacral edema, frequently seen in those with edema who have been in bed for long periods).
Swelling is often worst after sitting or standing for a period of time (due to gravity), and may be worse at the end of the day. Pushing on the swollen area for a few seconds will leave a dimple in the skin (show picture 1). Increased size of the abdomen (with ascites) Shortness of breath (with edema in the chest)
CONDITIONS ASSOCIATED WITH EDEMA — A number of different problems can cause edema.
Chronic venous disease — A common cause of edema in the lower legs is chronic venous disease, a condition in which the veins in the legs cannot pump enough blood back up to the heart because the valves in the veins are damaged. This can lead to fluid collecting in the lower legs, thinning of the skin, and in some cases, development of skin sores (ulcers) (show picture 2). (See "Patient information: Chronic venous disease").
Edema can also develop as a result of a blood clot in the deep veins of the lower leg (called deep vein thrombosis). In this case, the edema is usually limited to the feet or ankles and may affect only one side (the left or right); other conditions that cause edema usually cause swelling of both legs. (See "Patient information: Deep vein thrombosis (DVT)").
Pregnancy — Pregnant women retain extra fluid. Swelling commonly develops in the hands, feet, and face, especially near the end of pregnancy. Swelling during pregnancy is not necessarily a sign of preeclampsia (sometimes called toxemia). (See "Patient information: Preeclampsia").
Monthly menstrual periods — Edema is women that occurs in a cyclic pattern (usually once per month) can develop as a result of hormonal changes related to the menstrual cycle. This type of edema is common, but does not require treatment because it resolves on its own.
Drugs — Edema can be a side effect of a variety of medications, including some oral diabetes medications, high blood pressure medications, non-prescription pain relievers (such as ibuprofen), and estrogens.
Kidney disease — The edema of kidney disease can cause swelling in the lower legs and around the eyes. (See "Patient information: Chronic kidney disease").
Heart failure — In heart failure, also called congestive heart failure, the heart is weakened and its pumping action is impaired. Heart failure can cause swelling to develop in the legs and abdomen, as well as other symptoms. Heart failure can also cause fluid to accumulate in the lungs (pulmonary edema), causing shortness of breath. (See "Patient information: Heart failure causes, symptoms, and diagnosis").
Cirrhosis — Cirrhosis is scarring of the liver from various causes, which can obstruct blood flow through the liver. People with cirrhosis can develop pronounced swelling in the abdomen (ascites) or in the lower legs (peripheral edema). (See "Patient information: Cirrhosis").
Travel — Sitting for prolonged periods, such as during air travel, can cause swelling in the lower legs. This is common and is not usually a sign of a problem. Table 1 provides tips to minimize leg swelling during travel (show table 1).
If your leg(s) remain swollen or you develop pain hours or days after the flight, contact your healthcare provider. Continued swelling and pain can be signs of a blood clot (deep vein thrombosis or DVT). (See "Patient information: Deep vein thrombosis (DVT)").
thank you for the update. I will have to answer your questions as time and space permits . here is for Q 1
best wishes
1st Q: what can she do, besides lasix pills, to get rid of the fluid in her legs?
Fluid in the legs can be because of a low protein level. This is dues to malnutrition from being severely ill. The medical term for this is anasarca.
Here is a good patient education summary from UpToDate
Patient information: Edema (swelling)
Author
Burton D Rose, MD Section Editor
Robert H Fletcher, MD, MSc Deputy Editors
Leah K Moynihan, RNC, MSN
David M Rind, MD
Last literature review version 17.2: May 2009 | This topic last updated: May 8, 2009 (More)
EDEMA OVERVIEW — Edema is the medical term for swelling caused by a collection of fluid in the small spaces that surround the body tissues and organs. Edema can occur nearly anywhere in the body. Some of the most common sites are: The lower legs or hands (also called peripheral edema) Abdomen (also called ascites) Chest (called pulmonary edema if in the lungs and pleural effusion if in the space surrounding the lungs)
Ascites and peripheral edema can be uncomfortable, and can be a sign of a more serious condition. Pulmonary edema, which can be life-threatening, is a symptom of heart failure and is discussed in more detail separately. (See "Patient information: Heart failure causes, symptoms, and diagnosis").
EDEMA SYMPTOMS — Symptoms of edema depend upon the cause, but may include: Swelling or puffiness of the skin, causing it to appear stretched and shiny. This is typically seen in the lower legs (called peripheral edema) or lower back (called sacral edema, frequently seen in those with edema who have been in bed for long periods).
Swelling is often worst after sitting or standing for a period of time (due to gravity), and may be worse at the end of the day. Pushing on the swollen area for a few seconds will leave a dimple in the skin (show picture 1). Increased size of the abdomen (with ascites) Shortness of breath (with edema in the chest)
CONDITIONS ASSOCIATED WITH EDEMA — A number of different problems can cause edema.
Chronic venous disease — A common cause of edema in the lower legs is chronic venous disease, a condition in which the veins in the legs cannot pump enough blood back up to the heart because the valves in the veins are damaged. This can lead to fluid collecting in the lower legs, thinning of the skin, and in some cases, development of skin sores (ulcers) (show picture 2). (See "Patient information: Chronic venous disease").
Edema can also develop as a result of a blood clot in the deep veins of the lower leg (called deep vein thrombosis). In this case, the edema is usually limited to the feet or ankles and may affect only one side (the left or right); other conditions that cause edema usually cause swelling of both legs. (See "Patient information: Deep vein thrombosis (DVT)").
Pregnancy — Pregnant women retain extra fluid. Swelling commonly develops in the hands, feet, and face, especially near the end of pregnancy. Swelling during pregnancy is not necessarily a sign of preeclampsia (sometimes called toxemia). (See "Patient information: Preeclampsia").
Monthly menstrual periods — Edema is women that occurs in a cyclic pattern (usually once per month) can develop as a result of hormonal changes related to the menstrual cycle. This type of edema is common, but does not require treatment because it resolves on its own.
Drugs — Edema can be a side effect of a variety of medications, including some oral diabetes medications, high blood pressure medications, non-prescription pain relievers (such as ibuprofen), and estrogens.
Kidney disease — The edema of kidney disease can cause swelling in the lower legs and around the eyes. (See "Patient information: Chronic kidney disease").
Heart failure — In heart failure, also called congestive heart failure, the heart is weakened and its pumping action is impaired. Heart failure can cause swelling to develop in the legs and abdomen, as well as other symptoms. Heart failure can also cause fluid to accumulate in the lungs (pulmonary edema), causing shortness of breath. (See "Patient information: Heart failure causes, symptoms, and diagnosis").
Cirrhosis — Cirrhosis is scarring of the liver from various causes, which can obstruct blood flow through the liver. People with cirrhosis can develop pronounced swelling in the abdomen (ascites) or in the lower legs (peripheral edema). (See "Patient information: Cirrhosis").
Travel — Sitting for prolonged periods, such as during air travel, can cause swelling in the lower legs. This is common and is not usually a sign of a problem. Table 1 provides tips to minimize leg swelling during travel (show table 1).
If your leg(s) remain swollen or you develop pain hours or days after the flight, contact your healthcare provider. Continued swelling and pain can be signs of a blood clot (deep vein thrombosis or DVT). (See "Patient information: Deep vein thrombosis (DVT)").
6th Q: How likely after having VATS procedure do you see patients having the fluid come back? and if it comes back how soon after the procedure?
7th Q: Overall I've briefly explained what do you think the prognosis for my Mom is? Can she get back to her
ormal self as she was 4 months ago?
Thank You so much for your input and sorry if this post is so long
Caring daughter
Fiana
7th Q: Overall I've briefly explained what do you think the prognosis for my Mom is? Can she get back to her
ormal self as she was 4 months ago?
Thank You so much for your input and sorry if this post is so long
Caring daughter
Fiana
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