RE: Help for ?

[Guest guest]

* No need to suffer pain and discomfort to the degree described. Doctors should be handling it better than that. See Pat Walsh Surviving Prostate Cancer p. 516-7 Best wishes -- Sam 

 

I have some comments for what they are worth *in-line* following the thread. Sam

 

Caceres has mailed me about his father Washington, asking

questions that I cannot answer adequately. If any of you would like to help him

by responding to him directly, his e-mail address is caceres1@... If you respond here,

I will forward your mails to him. The details of his Washington’s diagnosis and current

position are:

 

 

He is 72 years old and was diagnosed back in January

2009 with advanced prostate cancer  with a PSA of 125ng/mg, Gleason Score not known

with metastases to the bone (pelvic and spine).. His initial therapy was ADT

(Androgen Deprivation Therapy)- specifics not stated, but probably immaterial. During

the period of hormonal treatment around October 2010 the metastases spread to

the Dura Mater, the outermost of the three meninges that surround the brain and

spinal cord. He was treated with radiation for that.

 

The last treatment he received was Taxotere. He

received five infusions this year (started in July) where he suffered some

of the side effects that you would expect but coped pretty well under the circumstances.

For the first four infusions PSA slowly dropped from 300ng/ml to 201 ng/ml

but after the 5th infusion back in October 2011 PSA went up to

310ng/ml.The oncologist said that Taxotere was no longer effective and she

offered my dad a trial with Abiraterone Acetate (Zytiga).The onco wants to

start him on the new drug (Zytiga) on January 11, 12. *Best advised to take it. From what I have heard it is effective in many cases and has few if any more side effects than LHRH-a*

 

Back in Feb 2011 my father contracted shingles. * Immune system messed up by LHRH-a*He

had spots around his neck and jaw area .After this episode he started

complaining of pain around his mouth. I mentioned this to the doctors and was

told that it might be Paget's Disease and that Zometa infusions would treat

this disease. During the Taxotere infusions he was also given 3 Zometa

infusions. The pain around his mouth still persists and he also says that he

feels pain inside his mouth, specifically in the gums. *Could be a mouth infection* We suspect that Osteonecrosis

of the Jaw (ONJ). might be present due to Bisphosphonate like Zometa. *Possible but unlikely due to the short time scale. ONJ can take years to develop - and with fairly consistent use of high strength bisphosphonates*

 

goes on to say:

 

I'm confused and a bit lost as to what to do next. I've

got the following doubts and questions : -

 

1.

My dad has to go for Zometa infusion on the January 4, 2012. If this

is what's causing ONJ( gum pain),should he keep having Zometa? Is there

some thing else instead ?

 

2.

If it is ONJ, what treatment, antibiotics are available for it?*It will resolve - eventually - after BP are stopped* 

 

3.

At present for bone pain caused by metastases in the spine and skull

area he's taking Endone (oxycodone hydrochloride) and Panadol together and

only helps for a while. * * How much is he taking ? Ideally he should have a slow release dose ( " oxycontin " and a normal dose ( " oxynorm " ) for breakthrough pain* I think these are constipating him. He hasn't had a

number 2 for three days. Can you suggest something else? A laxative for

constipation? *IMHO lactulose is best for this because it reverses the osmotic effect of the opoid Need to keep bowels open to maintain appetit amongst other things if he does not eat he will weaken* Something to help him to at least have a good sleep at night?

 

4.Since

a week before Christmas vomiting has been a problem. Everything (food) he

swallows he vomits. Based on your experience, how can I help him with the

vomiting?

 *There are meds available to reduce nausea and sickness - should have been given them when he did XRT e.g. metoclopromide *

* No need to suffer pain and discomfort to the degree described. Doctors should be handling it better than that. See Pat Walsh Surviving Prostate Cancer p. 516-7 Best wishes -- Sam 

 

 

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going

strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

 

1 of 1 File(s)

walsh.morphine.pdf

[Guest guest]

,I am afraid I do not know an awful lot about Zytiga - yet. Although I am sure we all have a lot of 'catch-up' to do. In the UK and elsewhere Zytiga has been passed for use after failure of chemotherapy. Some countries like to do their own research on top of the results already available, so maybe Australia is one of them. Terry would know more about that than me.  I can see the concern with you dad. I hope he gets something to control the mets and the pain.

Your question about oxynorm / oxycontin  ..Oxynorm is the usual oxycodone hydrochloride immediate release and comes in lower doses than ..

Oxycontin which is a slow release / timed release version of oxycodone hydrochloride. It is used so that patients do not need to keep taking tabs through the day to control their pain. Usually a high dose such as 40 or 60 or 80 mg to maintain a 'baseline' is taken at a specified time each day - say 12 noon and midnight. Then - for breakthrough pain - a smaller 5 - 10 mg tab oxynorm can be taken by the patient at any time.. 

Now a question from me about prednisolone. Anyone: Why is prednisolone used alongside Zytiga ? Chemo ? What happens if it is not taken with Zytiga ? Chemo ?

I realise it is an anti-inflammatory and see why it might be used with chemo - if the chemo is causing side effects & pain. But Zytiga ?Thanks,Sam.

Hi Sam / Terry,

I sincerely thank you from my heart for your advise.In regards to 3. At present for bone pain caused by metastases in the spine and skull area he's taking Endone (oxycodone hydrochloride) and Panadol together and only helps for a while. * * How much is he taking ? Ideally he should have a slow release dose ( " oxycontin " and a normal dose ( " oxynorm " ) for breakthrough pain*.He takes 1 x Endone + 2 x panadol tablets every six hours (last 2 days every 4 hrs).I don't anderstand the bit about  ( " oxycontin " and a normal dose ( " oxynorm " ).

 

To update you with the latest. On Wednesday the 29th at 10:30pm my dad was taken to hospital (emergency) due to no bowel movement and vomiting (as mentioned in my first message).Straight away they put him on the drip.I spent the night by his side on a couch and he went through it without major issues apart from waking up every now and then due to pain in the femur of the right leg (mets) and in the back of the head (mets).He did not eat anything only drank a bit of apple juice.By 11 am on the 30th they took x-rays to the stomach and head area.Dr told me that results showed constipation only.Later on a nurse perform an enema on him and minutes later he had bowel movement.After that he was admitted into a ward in oncology and spent the whole day without major complications apart from the usual which was controlled with pain killers.The bowel movement continued and the vomiting stopped.On Saturday yhe 31rst the junior dr at hospital says that he will have to stay for a couple of days to wich my dad opposed.He told the dr that he was feeling and that he did not want to spend new yrs eve and new yrs day in hospital,he wanted to be home with family.While my father was getting things ready to leave I had a talk to the young (junior) doctor and I asked why did they want to keep him in hospital.He told me that the x-rays showed mets spots in the actual brain.I was devastated by the news but I did not want my father to notice my deception so I pretended as if everything was still the same.

 

Sam / Terry, He's got to see the onco on the 11th to start Zytiga.I'm afraid the onco might say that due to mets in the brain he might not qualified for the trial. She would probably recomend radiation to the head which I think that in the present physical state of my father this will cause more deterioration.I don't think he will cope with the side effects of radiation.What do you think? Shouldn't they just go ahead and give him zytiga? I believe this drug's purpose is to stop mets from spreading so what's the difference if mets is present in the brain?

Once mets invades an organ (the brain).What's the survival rate?

 

Thanks again

 

Re: Help for ?

* No need to suffer pain and discomfort to the degree described. Doctors should be handling it better than that. See Pat Walsh Surviving Prostate Cancer p. 516-7 Best wishes -- Sam 

 

I have some comments for what they are worth *in-line* following the thread. Sam

 

Caceres has mailed me about his father Washington, asking questions that I cannot answer adequately. If any of you would like to help him by responding to him directly, his e-mail address is caceres1@... If you respond here, I will forward your mails to him. The details of his Washington’s diagnosis and current position are:

 

 

He is 72 years old and was diagnosed back in January 2009 with advanced prostate cancer  with a PSA of 125ng/mg, Gleason Score not known with metastases to the bone (pelvic and spine).. His initial therapy was ADT (Androgen Deprivation Therapy)- specifics not stated, but probably immaterial. During the period of hormonal treatment around October 2010 the metastases spread to the Dura Mater, the outermost of the three meninges that surround the brain and spinal cord. He was treated with radiation for that.

 

The last treatment he received was Taxotere. He received five infusions this year (started in July) where he suffered some of the side effects that you would expect but coped pretty well under the circumstances. For the first four infusions PSA slowly dropped from 300ng/ml to 201 ng/ml but after the 5th infusion back in October 2011 PSA went up to 310ng/ml.The oncologist said that Taxotere was no longer effective and she offered my dad a trial with Abiraterone Acetate (Zytiga).The onco wants to start him on the new drug (Zytiga) on January 11, 12. *Best advised to take it. From what I have heard it is effective in many cases and has few if any more side effects than LHRH-a*

 

Back in Feb 2011 my father contracted shingles. * Immune system messed up by LHRH-a*He had spots around his neck and jaw area .After this episode he started complaining of pain around his mouth. I mentioned this to the doctors and was told that it might be Paget's Disease and that Zometa infusions would treat this disease. During the Taxotere infusions he was also given 3 Zometa infusions. The pain around his mouth still persists and he also says that he feels pain inside his mouth, specifically in the gums. *Could be a mouth infection* We suspect that Osteonecrosis of the Jaw (ONJ). might be present due to Bisphosphonate like Zometa. *Possible but unlikely due to the short time scale. ONJ can take years to develop - and with fairly consistent use of high strength bisphosphonates*

 

goes on to say:

 

I'm confused and a bit lost as to what to do next. I've got the following doubts and questions : -

 

1. My dad has to go for Zometa infusion on the January 4, 2012. If this is what's causing ONJ( gum pain),should he keep having Zometa? Is there some thing else instead ?

 

2. If it is ONJ, what treatment, antibiotics are available for it?

*It will resolve - eventually - after BP are stopped* 

 

3. At present for bone pain caused by metastases in the spine and skull area he's taking Endone (oxycodone hydrochloride) and Panadol together and only helps for a while. * * How much is he taking ? Ideally he should have a slow release dose ( " oxycontin " and a normal dose ( " oxynorm " ) for breakthrough pain* I think these are constipating him. He hasn't had a number 2 for three days. Can you suggest something else? A laxative for constipation? *IMHO lactulose is best for this because it reverses the osmotic effect of the opoid Need to keep bowels open to maintain appetit amongst other things if he does not eat he will weaken* Something to help him to at least have a good sleep at night?

 

4.Since a week before Christmas vomiting has been a problem. Everything (food) he swallows he vomits. Based on your experience, how can I help him with the vomiting?

 *There are meds available to reduce nausea and sickness - should have been given them when he did XRT e.g. metoclopromide *

* No need to suffer pain and discomfort to the degree described. Doctors should be handling it better than that. See Pat Walsh Surviving Prostate Cancer p. 516-7 Best wishes -- Sam 

 

 

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html