Request for some medical advice

[ravip]

Asking on behalf of a friend - Thai Female aged 50.
Was diagnosed with grade 2 cancer - clinical information summary attached.
Mastectomy surgery was performed on 24 May 2022
She is now on hormone therapy and has to get the injections and daily dose of Femara 2.5 mg tablets.

 

Now she is complaining of shoulder pain - both.

Sometimes feeling cold and then warm in awhile.

Also feeling very tired even after walking for 5 minutes slowly.

 

However, she drives, goes to work and basically leads a normal life.

 

What could be the cause of these discomforts? - so far she has not received any proper advice.
Should she consult a General Physician for advice?

 

Any recommendations would be highly appreciated.

Residing in Bangkok.

Thank you in advance.

 

[internationalism]

Just speculation - side effects of chemotherapy. It's common.

Possibly changing to another medicine. Or reducing dose and adding another medicine. Cocktails are more effective than single one.

If she is not happy with her doctor she can ask to change or move to a specialised oncology hospital. And second opinion from a private hospital, if too long wait at the governmental. Some the newest and probably better medicines are not available yet in the governmental, but she can get private - at inflated price. Or trying generic from india - even flying to india for a large supply.

Cancer markers c125 and others are cheap, just a few hundreds baht each. Ultrasound is some 2k. She can request it at the governmental hospital.

On margin - shoulders might be just muscular, effect of stress and tension. Weekly massage might help, also give her emotional support. 

For same support she should seek peer groups on the net, patient's organisations, onco fundations.

Maybe oncopsychologist, if that exists in thailand.

Stage 2 is treatable. Engage her with anti-cancer diet, supplements. Even as far as chinese medicine, accupuncture (that one might be effective for pain and for muscle tension)

 

Edited October 15, 2022 by internationalism

[ravip]

38 minutes ago, internationalism said:

Just speculation - side effects of chemotherapy. It's common.

Possibly changing to another medicine. Or reducing dose and adding another medicine. Cocktails are more effective than single one.

If she is not happy with her doctor she can ask to change or move to a specialised oncology hospital. And second opinion from a private hospital, if too long wait at the governmental. Some the newest and probably better medicines are not available yet in the governmental, but she can get private - at inflated price. Or trying generic from india - even flying to india for a large supply.

Cancer markers c125 and others are cheap, just a few hundreds baht each. Ultrasound is some 2k. She can request it at the governmental hospital.

On margin - shoulders might be just muscular, effect of stress and tension. Weekly massage might help, also give her emotional support. 

For same support she should seek peer groups on the net, patient's organisations, onco fundations.

Maybe oncopsychologist, if that exists in thailand.

Stage 2 is treatable. Engage her with anti-cancer diet, supplements. Even as far as chinese medicine, accupuncture (that one might be effective for pain and for muscle tension)

 

>>> Just speculation - side effects of chemotherapy. It's common.

She was not administered with chemo, but is on hormone therapy. But I read that the side effects of Femara 2.5 mg tablets can have fatigue and muscular pain.

 

>>> If she is not happy with her doctor she can ask to change or move...

Not really. She seems to be happy with the surgeon. Problem is, there are a couple of Doctors treating her -  The surgeon, the Dr who is administering the hormone injections, the Physiotherapist etc.

 

So far, non of them had given an answer to her post-surgery issues that I mentioned above. In fact, it was my idea for her to consult a new Dr - at least to get some advice to her discomforts, without changing the initial Doctors.

 

The main issue I feel is that many Doctors do not discuss and explain in detail about the patient's concerns.

 

Thank you very much for your suggestions. 

[internationalism]

she needs an experienced oncologist, who would see her old tests and order new once.

If she is happy with her position, she won't have proper care. She will be continued to be ignored.

Get private doctor, second opinion. Just a few k baht from some top specialist. At least she will be assured there is no progression.

Physio should be able to help with some pain. Prescribe treatments. Motivate her to do exercises for her condition. 

In my opinion - most governmental doctors don't care, don't have much empathy. Possibly don't have deep knowledge to interpret tests and to think outside box.

Also in thailand, as in some other countries, oncologists don't tell truth. They would tell to the closest family, but not to patient directly. If she went to hospital always alone, she might be missing some info. Tell her to go with husband, partner, and talk behind closed doors about her situation. That might also put some pressure on oncologist.

Also tell her to take easy on work and her home duties. She is ill and should rest and concentrate on her health. Look into complementary therapies, there are many.

 

 

[Lorry]

3 hours ago, ravip said:

Now she is complaining of shoulder pain - both.

Sometimes feeling cold and then warm in awhile.

Also feeling very tired even after walking for 5 minutes slowly.

 

Sounds like side- effects from Femara.

https://breastcancernow.org/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/side-effects-letrozole-femara

[VinnieK]

What is the hormone therapy for?

Not cancer related?

I would discontinue it asap if it's for vanity reasons. ????

[internationalism]

Breast cancer, as well as all reproductive cancers, are hormon related and hence treated with hormon therapy (lowering sex hormons). 
that is standard therapy, not experimental anymore (use to be some 20 years ago).  Has no any side effects, just lowered libido. It would stop progress, albeit not remove cancer.  
thats why she has both treatments at the same time. 
There are many more therapies, which are less harmful than radio and chemio. Those 2 are outdated once. However there are new drugs, targeted to each cancer, based on its genome. They are very expensive, as are used only by a very small population, so no mass production. Developing a new drug costs up to $1bln and producer try to recover that investment asap. 
National health services dont cover them because of price. In some poorer countries only old drugs are available and those are with side effects.
For example in thailand ketokonazole, which is cheap. That drug in thailand is qualified as hormonal drug, so she might also be prescribed or even self-prescribe that. 
The best is to use several drugs, a cocktail, iin small doses, they often work synergistically, enhance each other and have less severe side effects. 
 

I think majority of thai patients dont educate themselves and dont question doctors, they would follow without thinking about alternatives. That alternatives might be costly, if targeted drugs have to be imported. 
Thats why peer groups, cancer fundations are important. They educate and force doctors to take a better care.

In her case looks like she wasn't warned, and even aware, about side effects of this chemo, so she might think, that cancer progresses. Her bad mood worsens her symptoms

Edited October 16, 2022 by internationalism

[ravip]

3 hours ago, VinnieK said:

What is the hormone therapy for?

Not cancer related?

I would discontinue it asap if it's for vanity reasons. ????

Yes, the hormone therapy IS related to her cancer - seems this is an alternative to chemo & radiation therapies.

No, it is not related to vanity reasons.

[ravip]

2 hours ago, internationalism said:

Breast cancer, as well as all reproductive cancers, are hormon related and hence treated with hormon therapy (lowering sex hormons). 
that is standard therapy, not experimental anymore (use to be some 20 years ago).  Has no any side effects, just lowered libido. It would stop progress, albeit not remove cancer.  
thats why she has both treatments at the same time. 
There are many more therapies, which are less harmful than radio and chemio. Those 2 are outdated once. However there are new drugs, targeted to each cancer, based on its genome. They are very expensive, as are used only by a very small population, so no mass production. Developing a new drug costs up to $1bln and producer try to recover that investment asap. 
National health services dont cover them because of price. In some poorer countries only old drugs are available and those are with side effects.
For example in thailand ketokonazole, which is cheap. That drug in thailand is qualified as hormonal drug, so she might also be prescribed or even self-prescribe that. 
The best is to use several drugs, a cocktail, iin small doses, they often work synergistically, enhance each other and have less severe side effects. 
 

I think majority of thai patients dont educate themselves and dont question doctors, they would follow without thinking about alternatives. That alternatives might be costly, if targeted drugs have to be imported. 
Thats why peer groups, cancer fundations are important. They educate and force doctors to take a better care.

In her case looks like she wasn't warned, and even aware, about side effects of this chemo, so she might think, that cancer progresses. Her bad mood worsens her symptoms

>>>  so she might also be prescribed or even self-prescribe that. 

No, she is not taking any self prescribed drugs at all - not even vitamins.

 

>>> and dont question doctors, they would follow without thinking about alternatives.

Yes, I agree with you 100%. Unfortunately, some doctors seems to dislike patients asking questions... and when you are sick, you dare not upset your doctor.

[Sheryl]

13 hours ago, ravip said:

 I read that the side effects of Femara 2.5 mg tablets can have fatigue and muscular pain.

 

 

 

Exactly --  these are common side effects of the drug.

 

If they become intolerable ,she can ask her doctor about changing to a different drug. But that may not make much difference.

 

See also  https://breastcancernow.org/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/side-effects-letrozole-femara

 

For general tips on managing these side effects.

 

I do not think a change of doctors, or seeing a different doctor, will be of use.

 

Also I suggest you consider the possibility that in mentioning these things to you she is seeking sympathy rather than a solution.  Men often  assune that when women relate their problems they are expecting the man to come up with a solution. Usually not the case. Just be a supportive friend.

 

 

[ravip]

51 minutes ago, Sheryl said:

 

Exactly --  these are common side effects of the drug.

 

If they become intolerable ,she can ask her doctor about changing to a different drug. But that may not make much difference.

 

See also  https://breastcancernow.org/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/side-effects-letrozole-femara

 

For general tips on managing these side effects.

 

I do not think a change of doctors, or seeing a different doctor, will be of use.

 

Also I suggest you consider the possibility that in mentioning these things to you she is seeking sympathy rather than a solution.  Men often  assune that when women relate their problems they are expecting the man to come up with a solution. Usually not the case. Just be a supportive friend.

 

 

Thank you very much Sheryl.

Well noted your advice.

[ravip]

4 hours ago, Sheryl said:

 

Exactly --  these are common side effects of the drug.

 

If they become intolerable ,she can ask her doctor about changing to a different drug. But that may not make much difference.

 

See also  https://breastcancernow.org/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/side-effects-letrozole-femara

 

For general tips on managing these side effects.

 

I do not think a change of doctors, or seeing a different doctor, will be of use.

 

Also I suggest you consider the possibility that in mentioning these things to you she is seeking sympathy rather than a solution.  Men often  assune that when women relate their problems they are expecting the man to come up with a solution. Usually not the case. Just be a supportive friend.

 

 

Is it advisable to engage mild 0 exercises, whatever is possible - like walking etc., with these aches and pain?

[simple1]

44 minutes ago, ravip said:

Is it advisable to engage mild 0 exercises, whatever is possible - like walking etc., with these aches and pain?

I've had surgery for cancer which has required followup treatment by hormone therapy. I am a male, but oncologist and GP strongly recommend regular exercise which I have to say feels beneficial. One of the reasons is hormone treatment for cancer weakens muscle strenght and weight gain. However, check with the oncologist for feedback for relevance for your friend's condition.

[Sheryl]

57 minutes ago, ravip said:

Is it advisable to engage mild 0 exercises, whatever is possible - like walking etc., with these aches and pain?

Certainly exercise in moderation would be good.

[ravip]

On 10/16/2022 at 10:17 AM, Sheryl said:

 

Exactly --  these are common side effects of the drug.

 

If they become intolerable ,she can ask her doctor about changing to a different drug. But that may not make much difference.

 

See also  https://breastcancernow.org/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/side-effects-letrozole-femara

 

For general tips on managing these side effects.

 

I do not think a change of doctors, or seeing a different doctor, will be of use.

 

Also I suggest you consider the possibility that in mentioning these things to you she is seeking sympathy rather than a solution.  Men often  assune that when women relate their problems they are expecting the man to come up with a solution. Usually not the case. Just be a supportive friend.

 

 

Exactly --  these are common side effects of the drug.

 

Are these side effects temporary or will continue as long as she is taking it?

[internationalism]

Hormonal therapy is safe, it well might stop progress, but doesn't remove cancer. 

Chemo (and radio) is poisoning cancer, but also healthy cells. Almost always have side effects, sometimes very serious, like losing all scalp hair (that is just a sign of internal organs damage). It can be always worse. Sometimes has to be stopped and another, less harmful drug introduced. The new one might be not on the national health service list yet, even private insurance might refuse to cover. The newest, targeted once, are extremely expensive. In millions of bht or usd.

 

Healthy, anticancer diet should be looked into, food and vitamin supplements. 
If she doesn't know it yet, well into her treatment for many months, it means her medical team doesn't do their proper job. 

It means she doesn't care to educate herself and doesn't take care of her own health. Looks, like her professional work, family commitments are more important than herself. She should change priorities. 
There are readily available sources of info all over the net, if somehow she can't rely on medics. 
Personally i would search for a medic, who would tell me all about many different treatment options. There are very many in conventional and complementary medicine. 
Also a dietician, who knows their job (rather difficult in the governmental hospital - i have tried to talk to one).

 

There are also repurposed anticancer medicines, which are extremely cheap and readily available in each pharmacy, many of them with minimal side effects. Like mentioned earlier ketoconazole, which is antifungal, but made it to an official anticancer list in thailand.   http://www.thethaicancer.com/Webdocument/Onco_drug/Oncodrug_Letter/Oncodrug_Letter_K.html 

 

Belgian charity made a list of some 366 such medicines   https://www.anticancerfund.org/en/drug-repurposing

 

Very few oncologists in the governmental hospitals would care to know about them. More likely private once. 

Edited October 20, 2022 by internationalism

[ravip]

4 hours ago, internationalism said:

Hormonal therapy is safe, it well might stop progress, but doesn't remove cancer. 

Chemo (and radio) is poisoning cancer, but also healthy cells. Almost always have side effects, sometimes very serious, like losing all scalp hair (that is just a sign of internal organs damage). It can be always worse. Sometimes has to be stopped and another, less harmful drug introduced. The new one might be not on the national health service list yet, even private insurance might refuse to cover. The newest, targeted once, are extremely expensive. In millions of bht or usd.

 

Healthy, anticancer diet should be looked into, food and vitamin supplements. 
If she doesn't know it yet, well into her treatment for many months, it means her medical team doesn't do their proper job. 

It means she doesn't care to educate herself and doesn't take care of her own health. Looks, like her professional work, family commitments are more important than herself. She should change priorities. 
There are readily available sources of info all over the net, if somehow she can't rely on medics. 
Personally i would search for a medic, who would tell me all about many different treatment options. There are very many in conventional and complementary medicine. 
Also a dietician, who knows their job (rather difficult in the governmental hospital - i have tried to talk to one).

 

There are also repurposed anticancer medicines, which are extremely cheap and readily available in each pharmacy, many of them with minimal side effects. Like mentioned earlier ketoconazole, which is antifungal, but made it to an official anticancer list in thailand.   http://www.thethaicancer.com/Webdocument/Onco_drug/Oncodrug_Letter/Oncodrug_Letter_K.html 

 

Belgian charity made a list of some 366 such medicines   https://www.anticancerfund.org/en/drug-repurposing

 

Very few oncologists in the governmental hospitals would care to know about them. More likely private once. 

Thank you very much for your information.

[Sheryl]

14 hours ago, ravip said:

Exactly --  these are common side effects of the drug.

 

Are these side effects temporary or will continue as long as she is taking it?

They sometimes subside with time, but not always. Or may subside just in intensity

[ravip]

On 10/20/2022 at 10:30 AM, Sheryl said:

They sometimes subside with time, but not always. Or may subside just in intensity

Now it's almost 1 year since her surgery.

Her body aches are still existing. Dr has prescribed ULTRACET if unbearable. She finds it very tiring to walk. Legs are feeling numbed. Sometimes, the entire body feels itchy.

 

Is there ANY remedy?

[Sheryl]

34 minutes ago, ravip said:

Now it's almost 1 year since her surgery.

Her body aches are still existing. Dr has prescribed ULTRACET if unbearable. She finds it very tiring to walk. Legs are feeling numbed. Sometimes, the entire body feels itchy.

 

Is there ANY remedy?

The "remedy" would be to stop taking the Femara but that might have  prognostic implications (i.e. increase risk of cancer recurrence)

 

She needs to have a detailed discussion with an oncologist, explaining the severity of her side effects and asking for the pros and cons of discontinuing Femara at this time.

 

Could consider seeing one privately so as to have ample time for discussion. If so should bring complete records with her.

 

 

[ravip]

6 hours ago, Sheryl said:

The "remedy" would be to stop taking the Femara but that might have  prognostic implications (i.e. increase risk of cancer recurrence)

 

She needs to have a detailed discussion with an oncologist, explaining the severity of her side effects and asking for the pros and cons of discontinuing Femara at this time.

 

Could consider seeing one privately so as to have ample time for discussion. If so should bring complete records with her.

 

 

Thank you very much Sheryl.  I will discuss with her regarding your advice. 

[ravip]

15 hours ago, Sheryl said:

The "remedy" would be to stop taking the Femara but that might have  prognostic implications (i.e. increase risk of cancer recurrence)

 

She needs to have a detailed discussion with an oncologist, explaining the severity of her side effects and asking for the pros and cons of discontinuing Femara at this time.

 

Could consider seeing one privately so as to have ample time for discussion. If so should bring complete records with her.

 

 

Could consider seeing one privately so as to have ample time for discussion. 

 

Can you please recommend a good oncologist in Bangkok?

(I will be coming to Thailand soon, hence could make an appointment)

[Sheryl]

 

⁰w

 

3 hours ago, ravip said:

Could consider seeing one privately so as to have ample time for discussion. 

 

Can you please recommend a good oncologist in Bangkok?

(I will be coming to Thailand soon, hence could make an appointment)

Where is she currently being treated? As it would be ideal to see an oncologist also affillated with that hospital. 

[ravip]

1 hour ago, Sheryl said:

 

⁰w

 

Where is she currently being treated? As it would be ideal to see an oncologist also affillated with that hospital. 

She is been currently treated at Chulabhorn Hospital.

[Sheryl]

One of these doctors. Be sure she has all records with her.  that means the surgical path report, records of her medications, all scans etc, and most recent blood test results

 

https://www.bumrungrad.com/en/doctors/Harit-Suwanrusme

 

https://www.bumrungrad.com/en/doctors/Suthida-Suwanvecho

 

[DrukenMallardy]

On 10/16/2022 at 6:21 AM, VinnieK said:

What is the hormone therapy for?

Not cancer related?

I would discontinue it asap if it's for vanity reasons. ????

the hormone therapy is a treatment for breast cancer, it depends on the breast cancer subtype.  Some are affected by oestrogen.  It's standard practice around to world to provide hormone therapy in cases where it's required (you find out after tumour markers are done on the excised tumour).