unoffical question of the day – August 29, 2007

Question:

- Hide quoted text — Show quoted text – Likewise, I got to thinking about what is really going on under all the symptoms of those with anxiety disorders. What do you think the real issues are in people with anxiety disorders? What is really going on in us, hidden under all our symptoms? Chip great question, chip!!  i know there are things buried deep within me that i am afraid of, but i can’t put my finger on them somehow.  i often think these may be behind my anxiety condition.  they may be fears about abandonment and rejection but i can’t tell for sure. maybe i need a few years of good old-fashioned freudian psychoanalysis to unearth them. ;o)

Huh, that’s interesting TJ.  You’re making me think.  Thanks, I "think". kili — The charter is available at: http://readystump.algebra.com/~asapm

Response:

– Hide quoted text — Show quoted text – I watched a TV show this morning about 3 young women who had body dysmorphic disorder. They looked attractive and pretty to me, but each thought they had physical defects and "weren’t perfect enough". They felt so badly about their appearance that they tended to stay away from other people. One of them spent several hours per day staring into a mirror to observe her perceived imperfections. Another had 5 plastic surgeries even though she was still a teen. A common theme in all 3 women was perceived imperfections in their body, obsessing, worry, anxiety, and depression and sadness. And marked interference with their functioning. All they could focus on was their symptoms. Which got me to thinking about what was really going on in their minds underneath all those symptoms. Likewise, I got to thinking about what is really going on under all the symptoms of those with anxiety disorders. What do you think the real issues are in people with anxiety disorders? What is really going on in us, hidden under all our symptoms? Chip

I can only speak for me. I believe that such things as perfectionistic expectations came from living with someone who expected more of me than I could give.. perfect feelings toward her. (My mom).. she shunned any emotions I had that she would label "bad" – if I was angry with her, I would be shamed – so I kind of fell into the habit of disallowing my own true feelings and stuffing them. That’s my current theory anyway. I’m learning to search myself now and to at least uncover what lead me to this point of fear. Anxiety is fear – and fear is the flight in fight or flight.. and there must be a cause for wanting the flight. In digging through my own feelings, I’ve found that both my anxiety and other problems stem from other people sick as well..people I love, but people that were ill and hurt me. Sometimes underlying my fears is anger…and once I find anger I just forgive them..and lying under all that is the actual hurtful event. Funny you should ask this question as I was just delving into searching it within myself.. but I only speak for me, unsure of the universality of all of this. I think it may be a common denominator, most  of us were abused in someway by someone, or had an anxious, frightened person we later modeled our own thinking after.. and the genetic components, I can’t speak to that. I wonder if anxiety is like depression in that doctors don’t know if depressive thoughts cause brain chemistry or vice versa or  either causes the other.. Sally — The charter is available at: http://readystump.algebra.com/~asapm

Response:

What do you think the real issues are in people with anxiety disorders? What is really going on in us, hidden under all our symptoms?

        I’m not sure there is a "real" issue.  It’s not necessarily related to childhood.  I have more problems than people I know who had worse.  We just have overactive nervous systems.  That was probably was what made some childhood stuff more difficult to take.   Dennis — The charter is available at: http://readystump.algebra.com/~asapm

Response:

great question, chip!!  i know there are things buried deep within me that i am afraid of, but i can’t put my finger on them somehow.  i often think these may be behind my anxiety condition.  they may be fears about abandonment and rejection but i can’t tell for sure. maybe i need a few years of good old-fashioned freudian psychoanalysis to unearth them. ;o)

        I had several years of that sort of thing, and I don’t recommend it.   Later I had a CBT therapist who said that it just made me do more obsessing – and that makes a lot of sense to me!   Dennis — The charter is available at: http://readystump.algebra.com/~asapm

Response:

– Hide quoted text — Show quoted text – I watched a TV show this morning about 3 young women who had body dysmorphic disorder. They looked attractive and pretty to me, but each thought they had physical defects and "weren’t perfect enough". They felt so badly about their appearance that they tended to stay away from other people. One of them spent several hours per day staring into a mirror to observe her perceived imperfections. Another had 5 plastic surgeries even though she was still a teen. A common theme in all 3 women was perceived imperfections in their body, obsessing, worry, anxiety, and depression and sadness. And marked interference with their functioning. All they could focus on was their symptoms. Which got me to thinking about what was really going on in their minds underneath all those symptoms. Likewise, I got to thinking about what is really going on under all the symptoms of those with anxiety disorders. What do you think the real issues are in people with anxiety disorders? What is really going on in us, hidden under all our symptoms?

I was shy as a little boy. (and I’m shy as a big boy, come to think of it). I was criticized alot by my father till he died at age 85. My ex-wife sensed my vulnerability and went for the jugular because she had her own problems. I helped her turn into a witch. All the criticism I received (much of it from myself) HURT REALLY BADLY, because I’m so sensitive. I was emotionally abused and didn’t even know it. Cause I figured I had it coming. I don’t take shit from anyone anymore. If I get it from someone, there will be payback. (yeah, I’m angrey) Angrey cause I put up with so much abuse and didn’t stand up for myself. And yeah, I can overdo the payback bit. I’m a perfectionist cause if you’re perfect no one can criticize you (in theory). And you can’t get hurt. Hurt like I was in the past. If you don’t do things perfectly, you could make a mistake, and some unexpected consequence could occur. If you don’t have enough self-confidence, you are afraid you may not be able to handle the situation. (just one more reason to be perfect ) Whether the words of someone else can hurt me depend on my own self-esteem. If I have good self esteem, I can say to myself  "so what? I don’t care what you think. What I think is important". But when your self esteem is low, you *depend* alot on how others treat you. You make them your judges, instead of judging yourself. As far as genetics, hereditary components, hard-waring of the nervous they’re not the whole picture IMO. Just a part of a bigger picture that also has to do with how one is raised, how one is treated, the coping skills one is taught, what kind of emotional or physical trauma one undergoes, etc. The so-called biopsychosocial model of the mind. And there may be other factors unaware to mankind at this time. Alot of the stuff going on in the mind is subconscious, so it’s hard to know what is going on, unless we start looking for clues. Unless we start speculating as to what might be going on. Or if you are undergoing cognitive or behavior theory, some of the underlying problems can bubble to the surface and become apparant as a result of the *actions* you take, or as a result of lookng at the way you think, and changing the way you think. What are some of the themes in anxiety disorders? Hereditary factors. Dependence on others. Feeling inadequate. Low self esteem. Attempts at perfectionism. Prior or current stress. Prior psychological or physical trauma. Prior criticism. Overconcern with what others think. Oversensitivity. Fear of one’s own emotions. Lack of touch with one’s own emotions. I don’t know what it all boils down to. When you have a panic attack all you can think of is getting off the freeway, how long will the attack last, whether you’ll have a heart attack, and whether you’ll lose your mind and stay in a state of panic. You don’t think about, say, getting out of the trap your life has become, how to become more mature and independant, and how to free yourself of all your hangups. You don’t think "I’m safe because I’m Chip…..and Chip can take care of himself" Chip — The charter is available at: http://readystump.algebra.com/~asapm

Response:

– Hide quoted text — Show quoted text – I watched a TV show this morning about 3 young women who had body dysmorphic disorder. They looked attractive and pretty to me, but each thought they had physical defects and "weren’t perfect enough". They felt so badly about their appearance that they tended to stay away from other people. One of them spent several hours per day staring into a mirror to observe her perceived imperfections. Another had 5 plastic surgeries even though she was still a teen. A common theme in all 3 women was perceived imperfections in their body, obsessing, worry, anxiety, and depression and sadness. And marked interference with their functioning. All they could focus on was their symptoms. Which got me to thinking about what was really going on in their minds underneath all those symptoms. Likewise, I got to thinking about what is really going on under all the symptoms of those with anxiety disorders. What do you think the real issues are in people with anxiety disorders? What is really going on in us, hidden under all our symptoms? From what I’ve read and my own opinion of course. I think distorted body

image is a pshychological disorder similar to anorexia distortions except the symptoms and outcome are not the same. Where the focus is on looks, I think its a profound distortion, an exagerration and obsession of having to look perfect which would lead to loss of self esteem and self image because they don’t think they are perfect enough and no matter what they do to look better it is never good enough. I think it could leave to physical illness eventually if its not treated successfully. Its like those women you see on TV who constantly have plastic surgery even when it becomes dangerous to their health. I also think it involves a self hatred due to something that happened to them or whatever. They need a psychiatrist who is skilled in that kind of disorder and seems to be hard to treat. When someone is constantly worried how they look, and has so much self criticism, much anxiety and depression and sadness would surely follow and definitely interfere a great deal with their functioning in life. How could it not? I used to know a girl who was pretty and very nice but she criticized her looks noticeably often. I was always amazed when she said this. She went to another job and a couple of years later, I heard she died of breast cancer. She was only around 45. Mary — The charter is available at: http://readystump.algebra.com/~asapm

Response:

Likewise, I got to thinking about what is really going on under all the symptoms of those with anxiety disorders. What do you think the real issues are in people with anxiety disorders? What is really going on in us, hidden under all our symptoms? Chip

great question, chip!!  i know there are things buried deep within me that i am afraid of, but i can’t put my finger on them somehow.  i often think these may be behind my anxiety condition.  they may be fears about abandonment and rejection but i can’t tell for sure. maybe i need a few years of good old-fashioned freudian psychoanalysis to unearth them. ;o) — The charter is available at: http://readystump.algebra.com/~asapm

Response:

I watched a TV show this morning about 3 young women who had body dysmorphic disorder. They looked attractive and pretty to me, but each thought they had physical defects and "weren’t perfect enough". They felt so badly about their appearance that they tended to stay away from other people. One of them spent several hours per day staring into a mirror to observe her perceived imperfections. Another had 5 plastic surgeries even though she was still a teen. A common theme in all 3 women was perceived imperfections in their body, obsessing, worry, anxiety, and depression and sadness. And marked interference with their functioning. All they could focus on was their symptoms. Which got me to thinking about what was really going on in their minds underneath all those symptoms. Likewise, I got to thinking about what is really going on under all the symptoms of those with anxiety disorders. What do you think the real issues are in people with anxiety disorders? What is really going on in us, hidden under all our symptoms? Chip — The charter is available at: http://readystump.algebra.com/~asapm

Response:

Coming off Dixarit & Efexor

Question:

I was first DX’d 17 years ago in 1988, and had a lumpectomy followed by radiotherapy and then was prescribed tamoxifen for several years – I was 34 at the time. I loathed it because of the hot flushes and night sweats it gave me, and stopped before the 5 years because I hated it so much. My doc described tamoxifen as belt and braces, and I felt that if that made my life almost intolerable, then I’d rather do without the braces and just rely on the belt!! Steph

– Hide quoted text — Show quoted text – Hi Nick I am very curious on how your wife is doing.  At the age of 36, I was diagnosed with Breast Cancer (19 months ago), had a lumpectomy, chemo and radiation and then started taking tamoxifen in June, 2004.  I too am suffering from the terrible hot flushes.  I just found out about Effexor but my doctor thinks I should try Dixarit.  Currently I am not taking either one and after reading this about your wife I am not sure I want to take anything.  My doctors will not switch me to Arimidex because I was not postmenopausal prior to chemo.  Aside from the hot flushes and not sleeping did she have any other side affects?  Please let me know how she is doing.  I will soon have to make a decision on if I want to take either one of these drugs to get rid of the hot flushes.  I have contemplated even stopping the tamoxifen. Thanks

Response:

Hi Nick I am very curious on how your wife is doing.  At the age of 36, I was diagnosed with Breast Cancer (19 months ago), had a lumpectomy, chemo and radiation and then started taking tamoxifen in June, 2004.  I too am suffering from the terrible hot flushes.  I just found out about Effexor but my doctor thinks I should try Dixarit.  Currently I am not taking either one and after reading this about your wife I am not sure I want to take anything.  My doctors will not switch me to Arimidex because I was not postmenopausal prior to chemo.  Aside from the hot flushes and not sleeping did she have any other side affects?  Please let me know how she is doing.  I will soon have to make a decision on if I want to take either one of these drugs to get rid of the hot flushes.  I have contemplated even stopping the tamoxifen. Thanks

Response:

– Hide quoted text — Show quoted text – My wife was diagnosed with breast cancer 14 months ago, she had a lumpectomy and then radiation. She was taking tamoxifen for about 12 months and more recently she has been switched to Arimidex.  She has also been taking venlafaxine(Efexor) and clonidine (Dixarit) to help suppress the terrible hot flushes.   Also because she was getting hardly any sleep her GP perscribed Zopiclone. She is very keen to stop taking the venlafaxine & Clonidine, because of the side effects.   She has tried stopping both at once and has suffered severe headaches, shiverings and dramatic temperature swings and generally feeling unwell.   Her GP said just to stop taking them and the withdrawal symptoms would  pass. Has anyone else had experience of coming off these drugs, what advice can you give.  At the moment my wife has gone back to taking minimal doses of each, which seems to help a little. Many thanks Nick & Chrissie

Both drugs – especially the Clonidine have warnings about withdrawing them abruptly. If your doctor is not able to give you a safe withdrawal schedule, I suggest you call the pharmacist and let him help you with a withdrawal schedule. Most of these type drugs should not be stopped abruptly without a gradual withdrawal. My best wishes, eveline – Hide quoted text — Show quoted text –

Response:

My wife was diagnosed with breast cancer 14 months ago, she had a lumpectomy and then radiation. She was taking tamoxifen for about 12 months and more recently she has been switched to Arimidex.  She has also been taking venlafaxine(Efexor) and clonidine (Dixarit) to help suppress the terrible hot flushes.   Also because she was getting hardly any sleep her GP perscribed Zopiclone. She is very keen to stop taking the venlafaxine & Clonidine, because of the side effects.   She has tried stopping both at once and has suffered severe headaches, shiverings and dramatic temperature swings and generally feeling unwell.   Her GP said just to stop taking them and the withdrawal symptoms would  pass. Has anyone else had experience of coming off these drugs, what advice can you give.  At the moment my wife has gone back to taking minimal doses of each, which seems to help a little. Many thanks Nick & Chrissie

Response:

Swollen arm

Question:

Seven years ago, my wife had breast cancer with subsequent removal surgery and chemotherapy. All check-ups were absolutely fine until January of this year when the check-up revealed some suspicious-looking lymph nodes. So chemotherapy again, and suspicious-looking nodes disappeared. However, her left arm (the side the breast was removed) became very swollen. She has been told that this is because the agent used in the chemo (Taxol) has blocked ganglions thus provoking an accumulation of water in the arm. She has been through many sessions of ‘lymphatic drainage’ (is that the right term?) but all to no effect. Can anyone suggest a way of eliminating the accumulated water and restoring her arm to its normal size? Any suggestions gratefully appreciated as her doctor seems short of solutions right now.

Response:

– Hide quoted text — Show quoted text – Seven years ago, my wife had breast cancer with subsequent removal surgery and chemotherapy. All check-ups were absolutely fine until January of this year when the check-up revealed some suspicious-looking lymph nodes. So chemotherapy again, and suspicious-looking nodes disappeared. However, her left arm (the side the breast was removed) became very swollen. She has been told that this is because the agent used in the chemo (Taxol) has blocked ganglions thus provoking an accumulation of water in the arm. She has been through many sessions of ‘lymphatic drainage’ (is that the right term?) but all to no effect. Can anyone suggest a way of eliminating the accumulated water and restoring her arm to its normal size? Any suggestions gratefully appreciated as her doctor seems short of solutions right now.

Fluid circulation in the arm enters via arteries but leaves via two different pathways.  The blood from the arterial side goes through capillaries, where a portion of the water and dissolved material leaks out into the space between cells, becoming lymph.  Most of the blood goes back to the heart via veins, but the fluid that leaked out of the capillaries goes back into thin-walled vessels called lymphatic channels or vessels. The fluid filters through lymph nodes.  Damage to the nodes, from surgery or from chemo or radiation, impairs the return through this system, and the fluid accumulates in the arm. It may be that the symptoms will subside very slowly as healing from this lates round progresses.  It might not, or might improve without going away. In the meantime, an elastic sleeve can be purchased or, better yet, made to her exact size.  In the US, the most common brand is Jobst, but there are other good manufacturers.  Someone needs to measure her arm and hand (an elastic glove is usually separate from the sleeve).  Jobst does that by means of a strip of paper with perpindicular bands spaced allong it like teeth of a comb.  You run the strip up the arm then tape the side bands around the arm with cellophane tape, cut through the bands with a pair of scissors, then fold the mess up and send it off.  The sleeves are hard to get on; you will need cornstarch or talcum powder and it might even be a two-person job. There are other precautions.  Blood should not be drawn from that arm nor intravenous fluids administered on that side.  Blood pressure should be checked on the other side.  Infections in that arm should be treated quickly and aggressively; the lymph is an excellent growth medium for bacteria and infection can get very serious very quickly.  When prractical, sitting with the arm elevated will slow the accumulation of fluid and speed is drainage.

Response:

It may be that the symptoms will subside very slowly as healing from this lates round progresses.  It might not, or might improve without going away. In the meantime, an elastic sleeve can be purchased or, better yet, made to her exact size.  In the US, the most common brand is Jobst, but there are other good manufacturers.  Someone needs to measure her arm and hand (an elastic glove is usually separate from the sleeve).  Jobst does that by means of a strip of paper with perpindicular bands spaced allong it like teeth of a comb.  You run the strip up the arm then tape the side bands around the arm with cellophane tape, cut through the bands with a pair of scissors, then fold the mess up and send it off.  The sleeves are hard to get on; you will need cornstarch or talcum powder and it might even be a two-person job.

My post-surgery physiotherapist measured and gave me the sleeve and hand section. You might see if you can find one who can do that. You also might check a large pharmacy such as one connected with a medical clinic, if you have one.  We have one here that has a section devoted to splints, back braces, shower chairs etc. that carries the material and will help fit it for you.  I think you can even get a doctor’s prescription to pay for it if you have insurance.  The material is called Tubeygrip, I think.   Marilyn

Response:

Diagnostic Choice MRI?

Question:

<< Thanks, Do you know why would an MRI would be ordered after a bone scan identified a "hot spot"? Could it be to check brain and lungs? Greta  <BR<BR Greta, you are fortunate to be receiving that careful of monitoring.  My understanding is that an MRI can better identify bone mets than a bone scan. Where are you located and where are you receiving treatment?

Hi, I am located in the southwestern part of Connecticut, USA – treatment – once decided upon, will be from the Praxair Cancer Center. I am near enough to New Haven Univ. Hosp. if I ever need a 2nd opinion, but so far I am satisfied. Greta

Response:

<< Kaye how are things going? Alex  <BR<BR Reasonably well–I think.  Thanks for asking, Alex.  However, things are also a bit complicated–almost too complicated to explain. There have been things going on with my spine–but inconclusive, but reports are contradictory and inconsistent.  One of the spine dr.’s I saw (and only saw a 2nd one at the urging of the first) told me that I had bone marrow mets to all the vertabrae in my thoracic spine.  A second radiologist didn’t think that I had that at all and can’t recall whom but another dr.–my regular or former regular oncologist told me that the appearance of my thoracic spine may be affected by the medication I take for M.S. (betaseron–interferon beta).  I am most concerned, though, about my cervical spine.  I went off the Celebrex and Doxycycline for a short break this summer while taking Keflex (for redness in my lymphedema arm) which I was sure I did not need.  However, I thought I would take a medication break to see if any of the symptoms I’d been having (such as a bilateral hissing sound in both ears) may have been related to the Doxycycline or Celebrex.  I also went off them because sometimes a medication break can help the medications work better when restarted.  Anyway, while off them I had such severe neck pain I couldn’t sleep.  The pain was when I lay down at night primarily.   I am sitting here having a bit of a tough time reading–have been having minimal vertical double vision–hope it isn’t b.c. related. My neck began to hurt somewhat in July, primarily when seated. It sort of feels like it is crunching into my spine.  It isn’t that painful–more like a pressure.    My range of motion is still good.  It started hurting worse last night.  I think that may have been related to the awkward position I was in while having a PET scan yesterday.  This morning it hurt as well and the dizziness returned.  It is a different type of dizziness–this one I get an image of something going around horizontally in a somewhat slow, chunking manner.  I wonder if that means the benign paroxysmal positional vertigo is back?  I forgot to mention that the MRI showed some type of lesion in the C2 area.  One dr. thinks it’s possibly MS-related and another (spine dr.) said I should ask my onc about radiation and/or chemo.  I am totally confused.   Then there C6-C7 area is showing degeneration.  I am most concerned because there was change there on the MRI between July and September.  I have no idea what that means. Then there is the lumbar spine.  That’s a whole ‘nother story.  I am not sure what if anything is going on there.  However, the last MRI compared results with MRI a full year before and said area (reported to be cyst or mass) was stable.  However, MRI in between had said it was smaller and no longer had regular borders–and now appeared less likely to be a cyst.  We saw spine dr. who put up films taken a year apart and told us it was stable.  We asked about intervening MRI.  He said he didn’t have the films.   (We are quite sure he did).  He went on to tell us radiologists are hunan and make mistakes.  He also said they do not have to compare all films.  Not comparing two most recent when there was a change, however, is not following precedent.  We said we’d be more comfortable if they were compared.  He refused and suggested we see another dr.  It was too weird.  He also said that I/we were concentrating too much on the spine and that "I" might miss something else.  Huh???  "I" might miss something???  That was what led me to be more concerned about the cervical spine. I have been keeping up on the research on lobular and have learned that lobular mets can have a spotted appearance in areas affected (i.e. read description of lobular brain mets appearing as ’spotted throughout’ the given area in the brain).  Meanwhile I am back at work (was off for two months during the summer–am in education).  I have been training for the Susan G. Komen 3 Day 60 mile walk which will be the 2nd weekend in October.  This year has been a bit harder physically.  I have been experiencing pain in the upper (back?) part of my thigh and part of the hip (sacroiliac?) area. Last weekend one of my oldest daughter’s roommates moved in with us for a month.  She also is in med school in Boston but is doing a rotation out here in So.Cal at a family practice clinic. Oh, and I got a call earlier this week asking if I would be available for an interview for local paper for the Susan G. Komen 3Day Breast Cancer walk.  This will be my 2nd year at doing it, and my husband will be on the medical crew.  I know–I am a glutton for punishment. Sorry for the length of this…and that is only some.  I forgot to mention about the liver…won’t go into too much detail but am concerned because I again look 10 mos. pregnant–same way I was at time of dx.  However, just after dx and before surgery I lost 17.5 lbs after changing my diet–stopped milk products, sugar, and most processed foods and started some exercise.  Well, my system must have slowed down alot because since December  I’ve gained over 10 lbs (and am not eating enough to have done that).  And I forgot to mention my arm–the one with lymphedema–am wrapping that daily.  Sleeve doesn help–swelling got worse anyway.  I am concerned about chest wall recurrence on both malignant and benign sides.   The lymph node in my arm–non malignant side–was reported to be swollen by 3 different dr.’s.  Nothing has been done. Then when I  saw my onc last Spring he mumbled something about chest wall recurrence.  I talked briefly with my surgeon soon after and she mumbled something to the effect that if it were a chest wall recurrence they couldn’t operate because I had already had radiation. We tried to get a 2nd opinion whether anything I had going on could be possibly treated by cyberknife.  The appt. was  not successful.  Basically we were told that we needed to find an oncologist we could trust???  How can I trust any dr. when we can’t even get an honest 2nd opinion…sigh… Other than that (and am sure I left out more), I am doing okay.   How is everything going for you?  Take care….

Response:

<< could the pain you being off the celebrex. I am guessing the Celebrex helps to control the pain.  The question–what could tha pain be from–other than Panorama…. On a side note they took Vioxx off the mark due to increased heart attacks and strokes, celebrex is similar in nature. <BR<BR There is adifferentl way they make it, so my fywaa Marm is that anythujnt so there must be something music-related somewhere.

Response:

<< There is adifferentl way they make it, so my fywaa Marm is that anythujnt so there must be something music-related somewhere.  <BR<BR ????  I didn’t write the above–wonder where it’s  from and how it got there???

Response:

<< There is adifferentl way they make it, so my fywaa Marm is that anythujnt so there must be something music-related somewhere.  <BR<BR ????  I didn’t write the above–wonder where it’s  from and how it got

there??? Well, it was creative. If literature went the way of art, it would probably win a national prize. Tim

Response:

I take Celebrex for arthritic type knee pain, if I forget my knees remind me! I do think taking a drug holiday is never a bad idea, could the pain you being off the celebrex. On a side note they took Vioxx off the mark due to increased heart attacks and strokes, celebrex is similar in nature. Good to hear from you.

Response:

Hi, Is an MRI the only diagnostic choice for bone mets? Greta

Response:

The gold standard for diagnosing bone mets in a bone scan. —

– Hide quoted text — Show quoted text – Hi, Is an MRI the only diagnostic choice for bone mets? Greta

Response:

The gold standard for diagnosing bone mets in a bone scan.

Thanks, Do you know why would an MRI would be ordered after a bone scan identified a "hot spot"? Could it be to check brain and lungs? Greta

Response:

The gold standard for diagnosing bone mets in a bone scan. Thanks, Do you know why would an MRI would be ordered after a bone scan identified a "hot spot"? Could it be to check brain and lungs?

The bone scan has to be combined with another imaging method in order to differentiate between arthritic activity and cancer activity, as what it detects is areas of bone inflammation.  Usually the two have distinctive x-ray signatures and that is used to discriminate.  I’m sure an MRI would be better, but more expensive.  So this might be the purpose. Tim Jackson

Response:

<< Thanks, Do you know why would an MRI would be ordered after a bone scan identified a "hot spot"? Could it be to check brain and lungs? Greta  <BR<BR Greta, you are fortunate to be receiving that careful of monitoring.  My understanding is that an MRI can better identify bone mets than a bone scan. Where are you located and where are you receiving treatment?

Response:

Kaye how are things going? Alex —

– Hide quoted text — Show quoted text – << Thanks, Do you know why would an MRI would be ordered after a bone scan identified a "hot spot"? Could it be to check brain and lungs? Greta <BR<BR Greta, you are fortunate to be receiving that careful of monitoring.  My understanding is that an MRI can better identify bone mets than a bone scan. Where are you located and where are you receiving treatment?

Response:

Increased liver function test results / possible concern re other scan

Question:

that a blood profile will be abnormal in a healthy person a greater than 5 in 8.  The further a test is from the limits of the "normal" range, the greater the likelihood that it means something.   1.2 vs. 1.1 is not much to get worked up over.  <BR<BR Thanks for that explanation.  I didn’t think it was high enough to be of concern, although a few days before the test I did notice and comment about the tone of my skin–more ‘yellowy’; however, I don’t have any of that in my nails or eyes–but skin tone change was noticed by both  me as well as my husband a day or two before test was done.  Hopefully, it was just a fluke and nothing of concern.

Response:

– Hide quoted text — Show quoted text – ? I thought I had read the amount of lymphedema is not indictive of prognosis, but don’t quote me. Yes, I  have had that although for awhile had sudden increase in such in right leg which went away after I began walking and started statin drug–and of course have no clue if there is any connection between such. << Some labs say 1.2 is normalfor bili. I wouldn’t fester over this one.  <BR<BR Thanks, that’s good to hear, although it states "high" (abnormal) on the report.

First: Lab normals are determined by analyzing blood from a group of patients without KNOWN disease.  That usually is about 200 samples.  They then cut off the bottom 2.5% and the top 2.5% and call the rest normal.  It is a 95% confidence interval.  If the data are normally distributed or can be made fairly normal (i.e., the Gaussian bell-shaped curve), they take the average value +- 1.96 * standard deviation.  The standard deviation measures how spiky or smeared-out the curve is. You have one chance in 40 on any test that your blood will be below the lower limits of normal and one chance in 40 that it will be above, just by chance.  If the battery of tests includes 25 different numbers (a rather modest number for automated profiles these days), the probability that they will all be normal IN THE ABSENCE OF ANY DISEASE is 0.95^20 = 0.3585.  The chance that there wil be AT LEAST one abnormal, still in the absence of any disease, is 1-0.3585 = 0.6415.  The chances, then, that a blood profile will be abnormal in a healthy person a greater than 5 in 8.  The further a test is from the limits of the "normal" range, the greater the likelihood that it means something.   1.2 vs. 1.1 is not much to get worked up over. Second: You need to know what your previous values were and you need to know the proportion of direct-reacting (conjugated) bilirubin and indirect (unconjugated) bilirubin are to know whether this is abnormal for you. My bilirubin has run around 1.8 for years because I have a condition know as Gilbert’s Syndrome.  It is associated with no known disease condition, it just reflects a variant in the way my body handles bilirubin.

Response:

thought I had read the amount of lymphedema is not indictive of prognosis, but don’t quote me.   Yes, I  have had that although for awhile had sudden increase in such in right leg which went away after I began walking and started statin drug–and of course have no clue if there is any connection between such. << Some labs say 1.2 is normalfor bili. I wouldn’t fester over this one.  <BR<BR Thanks, that’s good to hear, although it states "high" (abnormal) on the report.

Response:

" Latest–dr. ordered Doppler ultrasound after I told nurse that there was swelling/thickening in the armpit area.  I was told by tech after test that all was ‘good’ which I was surprised that he would share.  I would assume he would just tell me that films were acceptable and that was all, but he actually told me no DVT (deep vein thrombosis) which I was certain I didn’t have in the first place and thought this type of scan was not indicated from what was going

on. A DVT can present itself  by the symptoms you described I am glad they checked it out. So, when she called yesterday she did talk quite a bit–was interesting. She confirmed my thoughts–practicing medicine is just that–’practicing.’ It’s an art not an exact science.

Yes, I agree, I think we have talked about this here before. it was. She also said something that did not make me feel overly comfortable.  She told me that I had the worst case of lymphedema from breast cancer that she has seen.  She has been a breast surgeon for 22 years.

Didn’t you have lower lymphedema prior to breast cancer ? I thought I had read the amount of lymphedema is not indictive of prognosis, but don’t quote me.   Okay–then today I got results of some of my blood tests.  One of the liver tests was high–total bilirubin–was 1.2.  (Normal is < 1.0).

Some labs say 1.2 is normalfor bili. I wouldn’t fester over this one. Alex

Response:

I haven’t bored you with the details of my situation as of late–too complicated to even relate all that is going on.  My lymphedema arm has been worsening since December and have been again bounced around like a ping-pong ball re that situation.  It would almost be a comedy scene if it weren’t my life. Latest–dr. ordered Doppler ultrasound after I told nurse that there was swelling/thickening in the armpit area.  I was told by tech after test that all was ‘good’ which I was surprised that he would share.  I would assume he would just tell me that films were acceptable and that was all, but he actually told me no DVT (deep vein thrombosis) which I was certain I didn’t have in the first place and thought this type of scan was not indicated from what was going on. Afterwards, I received a call from my surgeon.  She talked to me for an extended period–maybe she felt guilty?  I saw her Monday morning as I was leaving the physical therapist (re. lymphedema).  That was also an appt. I didn’t really need since P.T. said we were doing everything possible and ‘right’ that I could be doing.  However, if I don’t follow recommendations of HMO I might be looked upon as uncooperative.  So, I go along  with their plan although do ask relevant questions–which I think may be getting me into ‘trouble.’ I won’t relate entire scenario re. what has transpired (everyone reading this is probably breathing a sigh of relief), but when I saw my surgeon I said I might need to be seen because of a new developed swelling (lump) in armpit area of arm w/lymphedema.  She commented to me that if something were going on, nothing could be done, because it wouldn’t heal.  That really made me feel, um, good–NOT! So, when she called yesterday she did talk quite a bit–was interesting.  She confirmed my thoughts–practicing medicine is just that–’practicing.’  It’s an art not an exact science.   Technically it should be exact but there is a lot we really don’t know.  She referred to a study done by one of the top pathologist’s in the country.  They had  the same specimen evaluated by 10 different pathologists–all considered some of the ‘best’–and the result was 10 differering opinions about what it was. She also said something that did not make me feel overly comfortable.  She told me that I had the worst case of lymphedema from breast cancer that she has seen.  She has been a breast surgeon for 22 years.   So, my thoughts are that what is going on may be return of the cancer.  Now, I haven’t gotten the full written report of the ultrasound but the tech also went over the armpit/axillary area.  There is a section which seems to be measuring something in that area.  It says axillary and I also think (nodes).  5 were shown with the largest being over a centimeter.   Of course,  I need to wait until the report is in before jumping to any conclusions, but still am a bit concerned. Then last night–was showing my daughter upper left arm–the one that has hurt for almost a year now.  And as I ran my hand over it I felt a soft ‘lump.’  She did too and said it felt like soft tissue and was movable.  I don’t know if that is good or not but also has me concerned. Okay–then today I got results of some of my blood tests.  One of the liver tests was high–total bilirubin–was 1.2.  (Normal is < 1.0). I am not surprised about what is going on.  Maybe, I am now desensitized.? Well, better go get ready to go stay w/friend–not sure when I will have a chance to get back on line.  

Response:

Is this normal practise in UK?

Question:

Hi Shaz , I am in Australia and here I see my surgeon every 6 months for two years , then will have regular check ups with my GP ps have had double mastectomy . take care Balsey

– Hide quoted text — Show quoted text – I recently went for an appointment with my surgeon exactly a year after my mast which was April 2003, (original diagnosis was Sept 2002, grade 3 stage 2 invasive ductal) and everything was ok. I wasn’t told to have anymore tests, I was just examined. My surgeon was please with the way my scar has healed and  asked me when I see my onc next. I told him that I haven’t been given another appointment to see her. The last time I saw her, she said that I didn’t need to see her anymore but that if i had any problems, not to hesitate about calling her. I am a bit confused why I have not got to have anymore tests, when most people on here seem to see their oncs quite regular. I was wondering whether this was normal practise in the UK, not to see your onc. after having chemo and radiotheraphy. I went for check-up sometime after finishing rads, (I can’t remember exactly when though) and have not seen my onc.since. It’s just a bit unnerving to see that nearly everyone else seems to still being seen by at least someone, be it either surgeon or onc.quite regularly after treatment has finished. Am I just worrying about nothing? Maybe i’m doing so well, they just don’t need to see me as often as some of the other gals on here? Thanks in advance for any help you might offer. Cheers, Shaz

Response:

The standard for care according to the American Society of Clinical Oncologists The attached guidelines and text summarize the updated recommendations of the ASCO breast cancer expert panel. Data are sufficient to recommend monthly breast self-examination, annual mammography of the preserved and contralateral breast, and a careful history and physical examination every 3 to 6 months for 3 years, then every 6 to 12 months for 2 years, then annually. Data are not sufficient to recommend routine bone scans, chest radiographs, hematologic blood counts, tumor markers (carcinoembryonic antigen, cancer antigen [CA] 15-5, and CA 27.29), liver ultrasonograms, or computed tomography scans.

– Hide quoted text — Show quoted text – Marilyns reply is my regimin also – see rad onc every 6 mos. and chemo onc every OTHER 6 months, 4 visits/year. They feel around, ask about meds (looking for side effects??), and schedule annual mammo and marker bloodwork along with liver/bone test once a year. They say that MRI or bone scans are only done when specific symptoms prompt that response – new pain in one place I suppose. They also refill my Rx’s for Femara as needed. I am 2.5 years out from surgery now. Chemo onc says 1 more 6 month visit, then 2 8-month visits then annual visits for ‘awhile.’ ALWAYS annual mammograms requested by my family doctor, more often if anything suspicious pops up. Ann in PA (USA)

Response:

Marilyns reply is my regimin also – see rad onc every 6 mos. and chemo onc every OTHER 6 months, 4 visits/year. They feel around, ask about meds (looking for side effects??), and schedule annual mammo and marker bloodwork along with liver/bone test once a year. They say that MRI or bone scans are only done when specific symptoms prompt that response – new pain in one place I suppose. They also refill my Rx’s for Femara as needed. I am 2.5 years out from surgery now. Chemo onc says 1 more 6 month visit, then 2 8-month visits then annual visits for ‘awhile.’ ALWAYS annual mammograms requested by my family doctor, more often if anything suspicious pops up. Ann in PA (USA)

Response:

I am a bit confused why I have not got to have anymore tests, when most people on here seem to see their oncs quite regular. I was wondering whether this was normal practise in the UK, not to see your onc. after having chemo and radiotheraphy. I went for check-up sometime after finishing rads, (I can’t remember exactly when though) and have not seen my onc.since. It’s just a bit unnerving to see that nearly everyone else seems to still being seen by at least someone, be it either surgeon or onc.quite regularly after treatment has finished. Shaz

Hi Shaz, I’m in Canada, so this doesn’t apply but I’ll tell you anyway.  I get to see two oncologists a year (six months apart) because I had chemo locally and had to travel for radiation to a major treatment centre, so both departments seem to have an interest. They both do a good breast exam, check for swollen glands (I think that’s what they are doing on my back and neck and underarms) and say "how are you doing?".  I have a blood test before I see my local onc. and I get a mammogram yearly. Probably ten minutes in and out. Cancer treatment in my area seems to be excellent, at least for me. Other areas of the health system are not so good, overworked, underpaid and understaffed. Marilyn

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– Hide quoted text — Show quoted text – Unless you have good reason to suspect that something is wrong, get on with  life and forget about cancer. Thanks for this very good advice! This is exactly what I plan to do now. I’m just going to enjoy my life as if I were just like anybody else. Maybe I have a slight advantage to many other ladies who haven’t been diagnosed with b.c? I will at least be given regular mammograms, even though i’m only 35! I should count myself lucky, that IF anything does pop up, at least it will be seen early! Thanks Tim, I apprieciate all your advice over the past year or so. But I feel I no longer need to visit here as often now. Maybe i’ll pop by from time to time. Until then, thanks & goodbye everyone,

Well done, Shaz! Do remember that if you’re at all concerned about anything you can go back at any time! Mary

Response:

I recently went for an appointment with my surgeon exactly a year after my mast which was April 2003, (original diagnosis was Sept 2002, grade 3 stage 2 invasive ductal) and everything was ok. I wasn’t told to have anymore tests, I was just examined. My surgeon was please with the way my scar has healed and  asked me when I see my onc next. I told him that I haven’t been given another appointment to see her. The last time I saw her, she said that I didn’t need to see her anymore but that if i had any problems, not to hesitate about calling her. I am a bit confused why I have not got to have anymore tests, when most people on here seem to see their oncs quite regular. I was wondering whether this was normal practise in the UK, not to see your onc. after having chemo and radiotheraphy. I went for check-up sometime after finishing rads, (I can’t remember exactly when though) and have not seen my onc.since. It’s just a bit unnerving to see that nearly everyone else seems to still being seen by at least someone, be it either surgeon or onc.quite regularly after treatment has finished. Am I just worrying about nothing? Maybe i’m doing so well, they just don’t need to see me as often as some of the other gals on here? Thanks in advance for any help you might offer. Cheers, Shaz

Response:

Unless you have good reason to suspect that something is wrong, get on with  life and forget about cancer. Thanks for this very good advice! This is exactly what I plan to do now. I’m just going to enjoy my life as if I were just like anybody else. Maybe I have a slight advantage to many other ladies who haven’t been diagnosed with b.c? I will at least be given regular mammograms, even though i’m only 35! I should count myself lucky, that IF anything does pop up, at least it will be seen early! Thanks Tim, I apprieciate all your advice over the past year or so. But I feel I no longer need to visit here as often now. Maybe i’ll pop by from time to time. Until then, thanks & goodbye everyone, Shaz xXx

– Hide quoted text — Show quoted text – Regular mammograms is the normal follow-up. It is normal to see the surgeon just once after surgery. There isn’t really a lot to see an oncologist about once you have completed treatment unless some symptom shows up. What did you want the oncologist to do?  One can make pro-active search for metastasis, but that is not generally considered a good idea.  Some US doctors and patients like to do this, but there is little evidence that it is useful.  At best you are likely to find a lot of things which are not quite ‘normal’ but are not cancer either, all our bodies have bumps and oddities.  At worst you are going to learn a little earlier that you have terminal cancer.  (Yes, I know that there is an argument that in some cases secondary cancer detected early can be held in remission for longer, but the general view is that in most cases it doesn’t make much difference to the outcome.) Unless you have good reason to suspect that something is wrong, get on with life and forget about cancer. Tim Jackson I recently went for an appointment with my surgeon exactly a year after my mast which was April 2003, (original diagnosis was Sept 2002, grade 3 stage 2 invasive ductal) and everything was ok. I wasn’t told to have anymore tests, I was just examined. My surgeon was please with the way my scar has healed and  asked me when I see my onc next. I told him that I haven’t been given another appointment to see her. The last time I saw her, she said that I didn’t need to see her anymore but that if i had any problems, not to hesitate about calling her. I am a bit confused why I have not got to have anymore tests, when most people on here seem to see their oncs quite regular. I was wondering whether this was normal practise in the UK, not to see your onc. after having chemo and radiotheraphy. I went for check-up sometime after finishing rads, (I can’t remember exactly when though) and have not seen my onc.since. It’s just a bit unnerving to see that nearly everyone else seems to still being seen by at least someone, be it either surgeon or onc.quite regularly after treatment has finished. Am I just worrying about nothing? Maybe i’m doing so well, they just don’t need to see me as often as some of the other gals on here? Thanks in advance for any help you might offer. Cheers, Shaz

Response:

Regular mammograms is the normal follow-up. It is normal to see the surgeon just once after surgery. There isn’t really a lot to see an oncologist about once you have completed treatment unless some symptom shows up. What did you want the oncologist to do?  One can make pro-active search for metastasis, but that is not generally considered a good idea.  Some US doctors and patients like to do this, but there is little evidence that it is useful.  At best you are likely to find a lot of things which are not quite ‘normal’ but are not cancer either, all our bodies have bumps and oddities.  At worst you are going to learn a little earlier that you have terminal cancer.  (Yes, I know that there is an argument that in some cases secondary cancer detected early can be held in remission for longer, but the general view is that in most cases it doesn’t make much difference to the outcome.) Unless you have good reason to suspect that something is wrong, get on with life and forget about cancer. Tim Jackson

– Hide quoted text — Show quoted text – I recently went for an appointment with my surgeon exactly a year after my mast which was April 2003, (original diagnosis was Sept 2002, grade 3 stage 2 invasive ductal) and everything was ok. I wasn’t told to have anymore tests, I was just examined. My surgeon was please with the way my scar has healed and  asked me when I see my onc next. I told him that I haven’t been given another appointment to see her. The last time I saw her, she said that I didn’t need to see her anymore but that if i had any problems, not to hesitate about calling her. I am a bit confused why I have not got to have anymore tests, when most people on here seem to see their oncs quite regular. I was wondering whether this was normal practise in the UK, not to see your onc. after having chemo and radiotheraphy. I went for check-up sometime after finishing rads, (I can’t remember exactly when though) and have not seen my onc.since. It’s just a bit unnerving to see that nearly everyone else seems to still being seen by at least someone, be it either surgeon or onc.quite regularly after treatment has finished. Am I just worrying about nothing? Maybe i’m doing so well, they just don’t need to see me as often as some of the other gals on here? Thanks in advance for any help you might offer. Cheers, Shaz

Response:

Skin biopsy

Question:

I am scheduled to have a biopsy this morning on a weird blister that popped up on my chest last week.  Actually, there were at least 5 lesions, two were clear liquid blisters and the others were hard and pink.  They were in a line towards where the bottom of my bra/prosthesis were.  At first I thought it was an irritation of some sort but that wouldn’t have been in a near-straight line (as opposed to curved) and wouldn’t have been separate bumps.  Of course my fearful imagination initially thought of something possibly cancer related.  I had my husband take a photo of it.  He also took video–just in case it was something that progressed a certain way and needed following. I had noticed it just before I undressed and went to bed.  Soon after I got into bed the thought of possible shingles popped into mind.  However, I would think from what I knew that shingles were painful.  Over the past month I did have some discomfort in that area which included burning pain and itching.  I had thought back to my initial discovery of the breast cancer which involved pain in that area of my chest but forgot to mention it to my oncologist and surgeon when I had seen them. Anyway, they were still there the following morning when I awoke.  I didn’t think it would be a great idea to wear my regular prostheses against them, so I put them into a pocketed sports bra.   My daughter who just graduated from college out-of-state had come in for the weekend.  We were making a party for her.  In addition when she returns to where she is living she will be a nanny for a newborn who was just adopted.  She never had chicken pox although she did have the vaccine 16 years ago in an experimental program.  I was concerned that if I had shingles that I might need to take some precaution and thought I had better check it out. I put a call into my surgeon.  She called me back and said it sounded like shingles except for the lack of pain.  I asked her if that area was somewhat numb and that some nerves?) had been cut, could that lessen or mask any possible pain.   She never thought of that but said that was a possibility. She said if it didn’t clear up then I should call her.  I  was able to get an appt. in internal medicine (with someone whom I’d never seen–which was fine for this).  Much to my surprise when I showed him the area which I hadn’t seen since the morning it looked very different.  There was one large, fluid-filled blister but the second blister wasn’t there and the other bumps were gone. After my description of it he said it sounded like shingles but didn’t want to treat only one.  I agreed.  If I hadn’t had the photos it would have been hard to believe that they had been as I had described. Meanwhile, my curiosit got the better of me over the weekend.  I looked up breast cancer, shingles, skin metastases and came to learn that there is a type of skin metastases called zosteriform that resembles shingles.   I was a bit ‘freaked’ when I further read that that should be  considered if it appears in linear form in the chest area of malignant side.  Great (not!).  I had been hoping it WAS shingles–something ‘normal’ that I could relax and not worry about it being cancer-related–at least for a short while anyway. My fears I think are reality-based because I did have dermal lymphatic invasion (inflammatory breast cancer), although I did have a rarer presentation. However, I am still getting red patches over my back on malignant side and they (oncologist and surgeon) are monitoring. Anyway, I emailed an article or two about this type of skin mets to my surgeon on Saturday and forgot about it.  I was surprised when I received a call from her nurse on Tuesday morning (for those not in the states, Monday was a national holiday) saying that she wanted me to have a biopsy of that single lesion.  I am guessing she is doing it to be on the safe side.  It has been there for about a week now. I am also  guessing (hoping) that it isn’t going to show anything.  I would be more concerned if there were still 5 or 6 there.  It was weird, though, how one of the blisters just disappeared as if it had never been there.  If we hadn’t taken a good picture  it would have been hard to believe they had all been there.  I wasn’t as surprised that the other separate hard red bumps disappeared so quickly–it was one of the blisters that was completely gone. It had been there before I went to bed and they were all the same at 7:00 in the morning. Except for the larger (about 1/8 in circumference) remaining blister all the others were gone by 5:00 that afternoon.  

Response:

<< I was clearly told when I was diagnosed that breast cancer is a systemic disease that often it lays dormant for long periods of time and then reappears. I was also told being node positive or node negative is not a exact science, that some women with small non invasive tumors die quickly from time of diagnosis and people with many nodes positve live full lives, there is no reliable test to know how people will respond after intial therapy.  You ar have many symptoms, but some if not all may not be cancer related, in fact the further you are away from your initial diagnosis the symptoms are less likely cancer related.Cancer pian is gets steadliy worse progressily not make you able to function. What you say is quite true.  However, at time of my dx my tumor markers were elevated.  At that time I wondered why tumor markers weren’t used to dx breast cancer.  I didn’t realize that once tumor markers are elevated that there is systemic disease going on and that the cancer was more advanced. I would be less concerned if I had run-of-the mill breast cancer rather than at least 2 of the 3 types I had.   Common sense and correspondence with others with similar symptoms suggest to me that something has been going on.  At the same time, the addition of ‘alternative’ medications–which have some valid research backing–suggests that these treatments may have had the/a desired impact.  Both my regullar oncologists believe that to be the case

Response:

My 2nd opinion onc said that people talk of cancer "coming back."  He went on to say, where does it come back from–the pathology lab?  In other words, the cancer if it shows up in recurrence for was always there.

I was clearly told when I was diagnosed that breast cancer is a systemic disease that often it lays dormant for long periods of time and then reappears. I was also told being node positive or node negative is not a exact science, that some women with small non invasive tumors die quickly from time of diagnosis and people with many nodes positve live full lives, there is no reliable test to know how people will respond after intial therapy.  You ar have many symptoms, but some if not all may not be cancer related, in fact the further you are away from your initial diagnosis the symptoms are less likely cancer related.Cancer pian is gets steadliy worse progressily not make you able to function. It sounds like you need a good physical exam by an internal medicine doc, who can help sort out many of your concerns. You have a daughter in medical school, she should be able to get the name of a doctor who can sort through these issues..

Response:

every day, excerise and able to access the computer, you function at a very high level I work  3 days/week by choice but may try and go back full time–because of potential retirement benefits should I be a long-term survivor. << As hard as you try there is no blatantly evidence of met disease that is confirmed by an oncologist.   I am not so sure of that with the on-going left shoulder, upper arm, and surrounding area pain with possibie enlarged nodes.  That pain started 10 months ago.  I have pain in my right hip and also pelvic bone and along the groin.  I have pain in right upper arm with increased lymphedema swelling–despite regular treatments and bandaging.   I have now developed another bout of dizziness.  I had  the Epley procedure. This time it didn’t help fully.  I have a headache in the back of my head above the neck with a feeling of numbness, tingling along spine.  I have shortness of breath–slight–with exhalation.  And most recently I have had weird skin stuff going on. True, my tumor markers have been normal.   However, one time when my onc bopped into the room and told me my markers were normal, I handed him a print out of alkaline phosphatase readings.  At that point it had made the largest jump since dx’d almost 22 mos. before.  It  had gone up 20 pts and only was a couple of pts. below normal.  With tumor markers one looks for steady increase which is what it had been doing. My 2nd opinion onc said that people talk of cancer "coming back."  He went on to say, where does it come back from–the pathology lab?  In other words, the cancer if it shows up in recurrence for was always there. I am on an IBC newsgroup.  One gal says her dr. doesn’t go by tumor markers–only symptoms and wants to know all changes, even those that are slight.   Another gal on that group was told her markers were normal last January.  She felt fine.  In March she had a skin recurrence.  5 weeks later she was dead.  That scenario is quite atypical for most cancers–but not unusual for IBC or other pleomorphic variant. Sometimes the only way to dx bone mets is through a bone marrow biopsy.  Latest research reports that would be quite useful or helpful to better treat. However, the NCI has not adopted that as standard practice, and it usually is not done.

Response:

<<< However, the type of lobular I had was pleomorphic–a rare, aggressive variant with a relatively short relapse free survival time.  I am hoping, though, that the Herceptin and other things I’ve done may have the propensity to make the cancer less aggressive.

 Correction, Kaye, you were diagnosis with very aggressive cancer like many of us here. You had initial treatment which was successful. You go to work every day, excerise and able to access the computer, you function at a very high level As hard as you try there is no blatantly evidence of met disease that is confirmed by an oncologist. Many women NEVER finish initial treatment with out  non questionable spread of the cancer one scan and BOOM it is diagnosied.  Other women die soon after there diagnosis that is aggressive cancer.which you don’t have. Presently, is seems that your oncologist feels you have No evidence of disease….you have had not had a firm diagnosis of Met disease ( please correct me oid I am wrong that an oncologist has told you you have met disease). of return of your"aggressive" cancer in 3 year therefore your disease isn’t aggressive

– Hide quoted text — Show quoted text – of one of my long-term-use products had changed, and/or I had developed a new allergy to it. I know one can develop a  hypersensitivity to things like latex.  I am not sure what the prostheses backing is made of.  However, what appeared was not typical for an allergic reaction—or most of it wasn’t anyway.  I still have one of the fluid filled lesions–although it is much less fluidy than it was 8 days ago.  Until the time they appeared the only thing against that area was the prosthesis.  However, the lesions were toward the bottome (as opposed to near mastectomy scar) and were in a horizontal line (bra is circular at that point)<< I know you’re concerned about potential for abdominal/digestive system mets from lobular BC.  A woman in my RL support group has such mets, and they seem to have been put in a so-far-quite-lengthy remission.  I don’t know details of her story (don’t know her extremely well) but believe the treatment for the mets included radiation. Thanks for sharing.  It’s good to hear positive, success stories. Generally, lobular is less aggressive and in most circumstances has at least a slightly more positive prognosis than ductal.  However, the type of lobular I had was pleomorphic–a rare, aggressive variant with a relatively short relapse free survival time.  I am hoping, though, that the Herceptin and other things I’ve done may have the propensity to make the cancer less aggressive.

Response:

of one of my long-term-use products had changed, and/or I had developed a new allergy to it.   I know one can develop a  hypersensitivity to things like latex.  I am not sure what the prostheses backing is made of.  However, what appeared was not typical for an allergic reaction—or most of it wasn’t anyway.  I still have one of the fluid filled lesions–although it is much less fluidy than it was 8 days ago.  Until the time they appeared the only thing against that area was the prosthesis.  However, the lesions were toward the bottome (as opposed to near mastectomy scar) and were in a horizontal line (bra is circular at that point)<< I know you’re concerned about potential for abdominal/digestive system mets from lobular BC.  A woman in my RL support group has such mets, and they seem to have been put in a so-far-quite-lengthy remission.  I don’t know details of her story (don’t know her extremely well) but believe the treatment for the mets included radiation. Thanks for sharing.  It’s good to hear positive, success stories.  Generally, lobular is less aggressive and in most circumstances has at least a slightly more positive prognosis than ductal.  However, the type of lobular I had was pleomorphic–a rare, aggressive variant with a relatively short relapse free survival time.  I am hoping, though, that the Herceptin and other things I’ve done may have the propensity to make the cancer less aggressive.

Response:

Dermatologist ’s will know what to do. It cracks me up when I go with my husband, to see the doc with  a thing that looks like a jewelers loop. Usually can tell you if it cancer or not by the look and feel but they have all the equipment to do a biopsy. Alex

– Hide quoted text — Show quoted text – << glad to see that you had it biopsy –wishing you quick and neg. results. Thanks, but when I saw her she said that it would be hard to biopsy since it was fluid-filled rather than a lump.  I am confused because I have read elsewhere that something like this could be biopsied.  She referred me to the dermatologist to have it checked.

Response:

<< glad to see that you had it biopsy –wishing you quick and neg. results. Thanks, but when I saw her she said that it would be hard to biopsy since it was fluid-filled rather than a lump.  I am confused because I have read elsewhere that something like this could be biopsied.  She referred me to the dermatologist to have it checked.

Response:

<< Any chance that it could be an allergic reaction of some sort?   <snip I haven’t changed anything re. soaps, fabrics.  

FWIW, I hadn’t either.  I finally concluded that perhaps the formulation of one of my long-term-use products had changed, and/or I had developed a new allergy to it. FYI, I know you’re concerned about potential for abdominal/digestive system mets from lobular BC.  A woman in my RL support group has such mets, and they seem to have been put in a so-far-quite-lengthy remission.  I don’t know details of her story (don’t know her extremely well) but believe the treatment for the mets included radiation.  She’s well enough that she’s taken some long-distance driving trips on her own (cross-country!), and you wouldn’t know she had metastatic BC to meet her, as her energy level and such seem very much in the normal range. Take care, Kaye — hope things work out well for you. Ann T.

Response:

<< Any chance that it could be an allergic reaction of some sort?   At first I thought it might be an irritation, even an allergic reaction to the prostheses.  However, if that were the case it would have been more widespread rather than along a single line.  I haven’t changed anything re. soaps, fabrics.  The initial reaction was under the area of the prostheses.   Any thoughts of possible malignancy were reinforced by the following: Zosteriform Metastatic Skin Cancer: Report of Three Cases and Review of the Literature Y. Kikuchi, A. Matsuyama, K. Nomura Department of Dermatology, Aomori Prefectural Central Hospital, Aomori, Japan Vol.

Celebrex

Question:

I am sure that I was on the drug for longer than that.  My husband was still alive in 1995 and I was taking it then.  I was working with a well known pain clinic in my area and they ‘tested’ it on me.  They were looking for people with severe osteoarthritis at the time.  And I sure did qualify.  So, it was several years (4+) prior to my cancer diagnosis.  I was taking a very large dose, too, I do remember that.  They had me maxed out trying to find me some relief.  I went off of the Celebrex because I acquired acute gastritis.  My gastro guy took me off.  It was one of many drugs that I took over 20+ years for my osteo.  It could be that other drugs started the problem, but I can tell you that according to my doctor, it was the Celebrex that brought that to a head.   And he believes that my eventual form of cholitis resulted in the medications that I took, also.  I think I really tore up my intestinal lining with these anti-inflammatories.  And yes, I know the percentages are small, but they are present. Osteoarthritis and osteoporosis do have one thing in common – calcium.  And any condition that keeps you from metabolizing your food correctly can cause a depletion of the required calcium that your body needs to maintain strong bones.  I got a great deal of relief from my pain by having some badly needed surgery 2 years ago.  It was extreme surgery (life-threatening with a long recovery), but it worked and I am here through that and BC and even the severe cholitis to tell you that life is still good!! Take Care,  Sharon

Response:

Sharon wrote  << I was working with a well known pain clinic in my area and they ‘tested’ it on me.   That is possible.  You should be able to get a copy of your records to verify. Also, often while taking a drug in the testing phase, the name of the drug is not known but given a code of some sort. << it was several years (4+) prior to my cancer diagnosis.  I was taking a very large dose, too, I do remember that.  They had me maxed out trying to find me some relief.  I went off of the Celebrex because I acquired acute gastritis. Another thought–you may have had breat cancer and not known it and if you were on mega doses of it, it could have been preventing tumor formation.  Then you went off it and the tumor took its natural course–just another possibility. << t could be that other drugs started the problem, but I can tell you that according to my doctor, it was the Celebrex that brought that to a head. That does sound like a possibility, although Celebrex is easier on one’s gastrointestinal tract than Ibuprofin.  Did you always take it with meals or substantial amount of food? << I think I really tore up my intestinal lining with these anti-inflammatories.   What other anti-inflammatories were you taking and when?  Were you off them at time of your breast cancer dx? If you were on several different anti-inflammatories, as you said, that could have started the process and the Celebrex didn’t help or reverse the problem. As far as Celebrex helping or preventing breast cancer, it only helps control one of the pathways (Cox2).  There are several different pathways that probably need to be addressed in the control/elimination  of cancer cells.  Recent research does show that it does help in that way with colon/rectal cancer.   I am at higher risk for mets to that area (retroperitoneal) because of the type of b.c.  I had (lobular). Here is a list of google websites for: pathway celecoxib and cancer Here is the address of just one of the articles which explains in lay terms how it can help with colon/rectal cancer. http://www.mc.vanderbilt.edu/reporter/?ID=2452

Response:

gleason wrote<< Is anyone taking Celebrex with Arimidex and or Fosomax for the purpose of prevention of BC and/or increasing Bone density?   Yes, I am taking Celebrex and Arimidex.  I started the Celebrex 9 mos. after I began Arimidex at 100 mg./twice/day.  One month later I increased it to 200 mg/twice/day.  About a month after I started it I noticed the ripply, fluid-like sensation I had when I exhaled was gone.  About 2 weeks after I increased the dosage, the occasional wheeze-like feeling that I also had and still had, also was gone.  I started taking the Celebrex about 5 weeks after my last Herceptin treatment. The change I noticed in breathing may have been related to that. About 3 mos. after I stopped the Herceptin my alkaline phosphatase level made the greatest increased to the pt. where it was only a few pts below normal.  I was concerned.  The following month I had a bone density test which showed osteopenia in one hip.  I started taking the antibiotic, Doxycycline, which also apears to help with bone loss and may prevent and/or possibly reverse bone mets as well.  I was also given an osteoporosis dosage of Zometa through IV infusion.  The month after that my alkaline phosphatase level stabilized.  The next month it again went down.    The month after that it went down even further to a level close to what it was at time of dx and so far it is still at that level. This past summer I also added Lovastatin to my medication regime.  That may have the potential to attack cancer cells from a different pathway.  Then the month after that my oncologist increased the dosage of Celebrex I am on to the maximum safe dosage–which appears to have the greatest anti-tumor effect–am on 400 mg/twice/day.  In addition to all that I take Levothroid (because I had become hypothyroid last year).  I also take interferon beta for M.S.

Response:

I find it interesting when I read about Celebrex.  I took it for years for my osteoarthritis, which I acquired at a very young age.  A result of a severe diving accident.  In any event, years after I started taking this medicine, I was diagnosed with breast cancer.  And a few years after that, I was diagnosed with osteoporosis.  The other sad thing is that I have also been diagnosed with severe colitis, most likely caused by years of anti-inflammatory (Celebrex) use.  My case may be anecdotal, but I personally question the validity of this drug’s use for those purposes and the long term use side effects.      Take Care,  Sharon

Response:

Sharon wrote << I find it interesting when I read about Celebrex.  I took it for years for my osteoarthritis, which I acquired at a very young age.  A result of a severe diving accident.  In any event, years after I started taking this medicine, I was diagnosed with breast cancer.  And a few years after that, I was diagnosed with osteoporosis.  The other sad thing is that I have also been diagnosed with severe colitis, most likely caused by years of anti-inflammatory (Celebrex) use.  My case may be anecdotal, but I personally question the validity of this drug’s use for those purposes and the long term use side effects.      Take Care,  Sharon   I thought Celebrex was a relatively new drug.  What years were you on it?

Response:

Sharon wrote << I find it interesting when I read about Celebrex.  I took it for years for my osteoarthritis, which I acquired at a very young age.  A result of a severe diving accident.  In any event, years after I started taking this medicine, I was diagnosed with breast cancer.   Sharon, how many years did you take it and when  were you diagnosed with breast cancer?  I am not sure what you mean by "years" but sounds like you took it over an extended time.  Celebrex was approved less than 5 years ago.   By the time breast cancer is discovered, it generally has been there for the past 5 to 10 years.  The time fram doesn’t fit for it to have caused breast cancer.  What dosage were you on?  The basic or low dosage of this is 100 mg/twice/day.   That would have minimal effect on cancer.  Double that dosage (200 mg/twice/day) appears to have  a stabilizing effect on cancer.   The dosage that appears to have a positive effect on tumor control is four times the lower dosage–which is 800 mg/day.  Approval for that did not come about until December 1999 which is less than four years ago. http://www.accessdata.fda.gov/scripts/cder/onctools/Accel.cfm It was not approved  at that dosage for that use before then.  If you were taking it for arthritis, you would not have been prescribed Celebrex at that level and thus, the highest dosage given for arthritis was not the dosage that has been shown to be most effective for tumor control. http://arthritis.about.com/library/weekly/aa010399.htm "Celebrex Approved By FDA On Thursday December 31, 1998, the United States Food and Drug Administration approved Celebrex(TM), (generic: Celecoxib) for the relief of the signs and symptoms of osteoarthritis and adult rheumatoid arthritis." <<And a few years after that, I was diagnosed with osteoporosis.  The other sad thing is that I have also been diagnosed with severe colitis, most likely caused by years of anti-inflammatory (Celebrex) use.  My case may be anecdotal, but I personally question the validity of this drug’s use for those purposes and the long term use side effects.   I may be wrong on this but I don’t think that the mechanisms responsible for osteoarthritis have anything to do with osteoporosis.  I don’t know anything about colitis.  However, I just looked it up and found that less than 0.1% (that’s zero pt. one percent) which would be less than one in one thousand happened to get colitis while taking Celebrex.  That does not mean that there is any relationship between getting colitis and taking Celebrex.  However, I am not sure what percentage of the population gets colitis but suspect it may be greater than one out of a thousand. Anyway, sorry that you have had these difficulties.  No fun

Response:

Is anyone taking Celebrex with Arimidex and or Fosomax for the purpose of prevention of BC and/or increasing Bone density?  Would be interested in information on appropriate indication and contraindications when both Breast Cancer and Osteoporosis are in the picture.  How much? How often?

Response:

HRT and Triptans

Question:

Karen, I’m with Hawki….get some Estrace.  I’m so hormonally touchy, but the Estrace is a godsend for me.  I am peri, but no hysterectomy…so I take a bcp too.  I can tell, however, whenever I drop my Estrace even 0.25 mg.  I can also tell when I add it back, I feel so much better. My doctor says it’s one of the best forms we can take, so see if you can get some Estrace and get off the Premarin. Good luck! Michelle

– Hide quoted text — Show quoted text – thanks hawki I am gathering info to take to the doc so that maybe…just maybe, he’ll finally listen to me about the premarin.  I’ve been trying to talk him into something else since the day he prescribed it. thanks again Karen only medication – premarin hormones get to the right level and therapeutic dose of premarin left at 1.25 m once a day Karen Premarin is about the worst choice for estrogen….as you know it is from "horse serum" and contains 17 female hormones…however many are NOT human hormones..and being from a horse..the amounts of each hormone can vary.. to get estrogen,..ask about Estradiol (estrace)…it is pure human estrogen,,and is the only exogenous estrogen needed (from outside the body).. ask for the smallest dose…5 mg..perhaps increase to 1.0 mgm if you start having hot flashes…but shouldn’t need higher.. remember…there HAVE been recent studies that "document" increased breast cancer risk with HRT…tho the study ONLY addressed Prepro….which essentially is Premarin PLUS a progestin..without a uterus..you don’t need a progestin Premarin is the WORST headache provacative estrogen I have ever prescribed….Estrace is the least… is the hysterectomy and the addition of the premarin. most likely the Premarin..tho the triptan side effects are NOT related…some folks do experience the chest symptoms even when they never did before.. good luck hawki

Response:

 I’ve been trying to talk him into something else since the day he prescribed it.

hmmm…remember Karen…YOU don’t have to take anything you don’t want to….if he won’t switch you to Estrace…fire him you might want to ask him why he thinks you need the 17 horse hormones??  and point to the studies that document that Estrace..estradiol is the only human female hormone needed… don’t back down Karen hawki hawki

Response:

thanks hawki I am gathering info to take to the doc so that maybe…just maybe, he’ll finally listen to me about the premarin.  I’ve been trying to talk him into something else since the day he prescribed it. thanks again Karen

– Hide quoted text — Show quoted text – only medication – premarin hormones get to the right level and therapeutic dose of premarin left at 1.25 m once a day Karen Premarin is about the worst choice for estrogen….as you know it is from "horse serum" and contains 17 female hormones…however many are NOT human hormones..and being from a horse..the amounts of each hormone can vary.. to get estrogen,..ask about Estradiol (estrace)…it is pure human estrogen,,and is the only exogenous estrogen needed (from outside the body).. ask for the smallest dose…5 mg..perhaps increase to 1.0 mgm if you start having hot flashes…but shouldn’t need higher.. remember…there HAVE been recent studies that "document" increased breast cancer risk with HRT…tho the study ONLY addressed Prepro….which essentially is Premarin PLUS a progestin..without a uterus..you don’t need a progestin Premarin is the WORST headache provacative estrogen I have ever prescribed….Estrace is the least… is the hysterectomy and the addition of the premarin. most likely the Premarin..tho the triptan side effects are NOT related…some folks do experience the chest symptoms even when they never did before.. good luck hawki

Response:

only medication – premarin hormones get to the right level and therapeutic dose of premarin left at 1.25 m once a day

Karen Premarin is about the worst choice for estrogen….as you know it is from "horse serum" and contains 17 female hormones…however many are NOT human hormones..and being from a horse..the amounts of each hormone can vary.. to get estrogen,..ask about Estradiol (estrace)…it is pure human estrogen,,and is the only exogenous estrogen needed (from outside the body).. ask for the smallest dose…5 mg..perhaps increase to 1.0 mgm if you start having hot flashes…but shouldn’t need higher.. remember…there HAVE been recent studies that "document" increased breast cancer risk with HRT…tho the study ONLY addressed Prepro….which essentially is Premarin PLUS a progestin..without a uterus..you don’t need a progestin Premarin is the WORST headache provacative estrogen I have ever prescribed….Estrace is the least… is the hysterectomy and the addition of the premarin.

most likely the Premarin..tho the triptan side effects are NOT related…some folks do experience the chest symptoms even when they never did before.. good luck hawki

Response:

Hi, I’ve got a strange question for you ladies (well guys too if you think you’ve got an answer…where is jack when you need him anyway) Case History: female, 40-ish, migraine sufferer, FMS patient only medication – premarin triptans have worked (sometimes better then others but they worked) for many years with at least moderate success from many of the different brands (off the top of my head, which seems to be broken today) imitrex, zomig, and maxalt have all worked in the past complete abdominal hysterectomy (in other words they ripped it all out) in Dec. 2002 post surgical migraines thought to have been being caused by lack of hormones and then getting them under control with HRT hormones get to the right level and therapeutic dose of premarin left at  1.25 m once a day ok…you’ve got the history now here’s the dilemma since the surgery if I dare take any triptans I end up with severe chest pains and my head feeling like it’s just going to explode.  I’ve asked the docs if it could be  an interaction with the premarin and they look at me like I’m nuts, but that’s the only thing that has changed!  My BP is good, a little on the low side but it’s good, yeah I smoke (not like a chimney anymore, but I smoke) but the only thing that has changed is the hysterectomy and the addition of the premarin. what do you guys think? just curious Karen

Response:

Symptoms of Bone Mets?

Question:

Hi All, For those who have bone mets, can you please describe the symptoms of these that led to your diagnosis? Was/is the pain a constant ache? Did/does it present like a skeletal injury? Is the pain associated with movement? Did it present suddenly or gradually? I have a rapid onset pain in my upper back / neck. It feels skeletal rather than muscular. It hurts me to move in certain directions. I’m wondering if this is "just" a bad back or whether it is a symptom of my breast cancer having spread to my bones? Over the last few weeks I’ve had the odd "twinge" and sore/tired lower back. In the past, I’ve rarely had any problems with my back and nothing like this. I don’t want to contact my oncologist and go for a bone and CT scan every time I have an ache or a pain or a cough. The thought of going through another bone scan and waiting for the results induces huge anxiety in me. Please help, Kim DX  February 2003, 34 yo Left Breast – Microcalcifications Right Breast – 4 x Infiltrating Ductal Carcinoma tumours, diameters 9 to 15mm, Nuclear grade 3, ER & PR + Lymphovascular involvement Node positive (3/31; 2 axilla, 1 IMC) Right MRM March 2003 4 x FAC and 2 x FEC, completed 23 July 2003 Radiotherapy 6 August to 15 September 2003 Tamoxifen started 16 September 2003

Response:

– Hide quoted text — Show quoted text – Hi All, For those who have bone mets, can you please describe the symptoms of these that led to your diagnosis? Was/is the pain a constant ache? Did/does it present like a skeletal injury? Is the pain associated with movement? Did it present suddenly or gradually? I have a rapid onset pain in my upper back / neck. It feels skeletal rather than muscular. It hurts me to move in certain directions. I’m wondering if this is "just" a bad back or whether it is a symptom of my breast cancer having spread to my bones? Over the last few weeks I’ve had the odd "twinge" and sore/tired lower back. In the past, I’ve rarely had any problems with my back and nothing like this. I don’t want to contact my oncologist and go for a bone and CT scan every time I have an ache or a pain or a cough. The thought of going through another bone scan and waiting for the results induces huge anxiety in me. Please help, Kim

Most of these questions don’t have definite answers, it varies from person to person, as the pain can arise by several mechanisms – bone chemistry, bone abrasion, structural failure or nerve pressure, and in many places. Mets tends to be characterised by a gradual and persistent worsening which is resistant to other treatments.  Yes, it can appear exactly like a ‘bad back’, my wife’s did, but most ‘bad backs’ recover naturally after a few weeks’ rest and mets doesn’t. Your oncologist would probably tell you to wait six weeks and see if it goes away.  Or even more likely, to go and see your GP or orthopod and get referred back to him if all else fails.  One doesn’t do bone scans lightly, the radioactive injections are expensive and bad for you. If you already had a clear bone scan it is unlikely that you would have developed symptomatic bone mets in a few months.  In my wife’s case it took over a year, and I believe that was fairly rapid. If it persists take it to your GP.  The oncologist only deals with cancer and isn’t trained to deal with or even recognise bad backs.  The approach to mets is basically to assume it isn’t, until everything curable has been ruled out. Tim Jackson

Response:

Hi Tim, Thanks for your reply. I had hoped you would post a response because I remember your wife’s BCa history and how you both thought she had injured her back moving some furniture and that she was a few weeks – months in physiotherapy before bone mets were diagnosed. Most of these questions don’t have definite answers, it varies from person to person, as the pain can arise by several mechanisms – bone chemistry, bone abrasion, structural failure or nerve pressure, and in many places.

Are you referring here to bone pain in general or pain arising from mets only? Mets tends to be characterised by a gradual and persistent worsening which is resistant to other treatments.  Yes, it can appear exactly like a ‘bad back’, my wife’s did, but most ‘bad backs’ recover naturally after a few weeks’ rest and mets doesn’t.

I have my fingers crossed. Even a simple bad back isn’t easy – I have a 20 month old toddler, still in a cot bed, and still in need to picking up from falls etc. Your oncologist would probably tell you to wait six weeks and see if it goes away.  Or even more likely, to go and see your GP or orthopod and get referred back to him if all else fails.  One doesn’t do bone scans lightly, the radioactive injections are expensive and bad for you.

Yes, I appreciate this. If you already had a clear bone scan it is unlikely that you would have developed symptomatic bone mets in a few months.  In my wife’s case it took over a year, and I believe that was fairly rapid.

That’s what I keep thinking. It is too soon. My clear scan was in early March 2003. It’s just that I haven’t had back problems before. And I’ve already had some incidents since my mastectomy – a lump on my chest wall – it was a haematoma; a suspicious mark on my mastectomy scar which is now dissipating; an ovarian cyst with a solid (tumour-like) area which was confirmed as benign after a laproscopic cystectomy. So I’m feeling a little paranoid. If it persists take it to your GP.  The oncologist only deals with cancer and isn’t trained to deal with or even recognise bad backs.  The approach to mets is basically to assume it isn’t, until everything curable has been ruled out.

I have made an appointment for later in the week to see my GP, just to get her more objective view on it. On another note, how are you, your daughter and stepson going? I haven’t been participating in this news group for some time (in short, my treatment has been complicated and I haven’t been well plus looking after my son…) but I do think of you and your daughter. Thanks again, Kim

Response:

Most of these questions don’t have definite answers, it varies from person to person, as the pain can arise by several mechanisms – bone chemistry, bone abrasion, structural failure or nerve pressure, and in many places. Are you referring here to bone pain in general or pain arising from mets only?

I was specifically referring to mets pain as having all these sources, although of course it may apply to bone pains of other origin too. On another note, how are you, your daughter and stepson going? I haven’t been participating in this news group for some time (in short, my treatment has been complicated and I haven’t been well plus looking after my son…) but I do think of you and your daughter.

Thank you for your interest.  Both are well and doing fine.  Natasha had her 10th birthday last week, with a slumber party at the weekend.  Artyom has got through his phase of inactivity and dead-end jobs, and joined the British Army.  He had his passing-out last week, so he is now officially a soldier, a Royal Engineer.  He is enjoying it and doing well.  That reminds me, I must update my website, Tim Jackson

Response:

If you don’t mind me asking…your daughter Natasha? Her 10th birthday was last week you said? My grand daughter is also "Natasha" and her 9th birthday was "last week" also..what day? Glad to hear everything is going well for both you and your children. I don’t post very much anymore, but make a point to come in here about once a week to check to see how everyone is doing. Take care there/God bless annie Ultimately…..we know deeply that the other side of every fear is a freedom. "Courage"…is *fear* that has said it’s prayers.

Response:

If you don’t mind me asking…your daughter Natasha? Her 10th birthday was last week you said? My grand daughter is also "Natasha" and her 9th birthday was "last week" also..what day? Glad to hear everything is going well for both you and your children. I don’t post very much anymore, but make a point to come in here about once a week to check to see how everyone is doing. Take care there/God bless annie

Thursday 16th. Hope your granddaughter had a good birthday and didn’t wear her parents out too much. Always nice to hear from you Annie. Tim

Response: