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Pain in lumbar region, breast cancer, solution for hair fall and dandruff - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Average Posted in: Breast Cancer
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1764 Questions
User :   hi
Doctor :   Hi
Doctor :  
How can I help you?
User :   i have a couple of questions
User :   1st about my husband...he is having lower back ache..
Doctor :  
please proceed with your query.
User :   infact its in the lumbar region ..on the left side
User :   it started of with lower back ache and then ...over a period of time...shifted to the lumbar region..which i believe is on the upperside of the buttocks...
Doctor :  
ok
User :   n he has some pain mostly ...whne he gets after sitting for more than 30 mins
Doctor :  
ok
User :   also if he bends his neck backwards...while sitting..he has more pain...
Doctor :  
plz proceed
Doctor :  
ok
User :   wat cld be the reason for this pain n wat should be done to get back to normal
User :   hi...r u there?
Doctor :   ya i am there

Doctor :  
there are other patients also i am consulting with
User :   okay
Doctor :   now about your husband back pain

User :   yes
Doctor :  
i have few questions
Doctor :  
did he consult any doctor for this
User :   yes...we did
Doctor :   what he said

User :   he actually went through some physio therapy sessions
User :   he consulted a physiotherapist
User :   he said..it was a repetitive strain injury
User :   after the sessions and some excercises there is marginal improvement
User :   but..the pain is still there...
Doctor :  
no i need wt doctor said not physio said
User :   we didnt consult any doctor
Doctor :  
this is wrong
User :   ok
Doctor :   now please explain me again what all symptoms he have

User :   it started with lower back ache....
User :   which he used to get after sitting contioously for prolonged hours
User :   thats the nature of his work..
Doctor :  
ok
User :   n then he started getting pain in the left upper buttocks to left lower back region
Doctor :  
what is the height and weight
User :   height 5.8
User :   weight 78 kilos
User :   the pain is more when he sits and gets up
Doctor :   so what physio you underwent

User :   he is more comfortable standing
User :   some heat radiation and some ultra sound
User :   along with some excercises to strengthen ..i guess the lumbar region
Doctor :   back pain is because of many reasons

User :   k
Doctor :  
it comes from bone muscle and nerve
User :   k
Doctor :  
now first of all the most common reason is muscle strain
User :   k
Doctor :  
but needs to be ruled out the bone and nerve cause
User :   k
User :   wat are typically the symptoms incase it is due to bone or nerves?
Doctor :   now i dont want to discuss about them and confuse you

User :   ok
Doctor :  
i suggest you to consult one orthopaedician for this problem
User :   ok..
Doctor :  
he will get the X ray and other investigation done
User :   k
Doctor :  
once it is done with the diagnosis we shall start the specific treatment
User :   k
User :   but the physio had a conversation with the ortho
User :   and the pysio has checked based on the doctors recommendation
Doctor :   there is lot difference between ortho consultation and a non doctor perception

Doctor :  
physio is not a doctor
User :   ya..he spoke to an ortho
Doctor :   speak is different from personal examination of patient

Doctor :   from your description i feel it is like the pain is because of muscular origin only
Doctor :  
now tell me since when he is having this problem
User :   more than 3 mnths
Doctor :   it is not old yet to be branded as chronic

Doctor :   there is a sequence of treatment for this
User :   ok
User :   wat do u suggest
Doctor :   first see orthopaedician and confirm the diagnosis

Doctor :  
than follow wt i say
Doctor :   you give him a oil massage

User :   ok
Doctor :   a to and fro smooth massage will relieve him
Doctor :  
use warm coconut oil
User :   k
Doctor :  
other things are
Doctor :  
ice application
User :   k
Doctor :  
ice cold water apply 3 to 5 minutes
Doctor :  
this you do 3 or 4 times a day
Doctor :   please fill the feed back form

Doctor :  
ice should not be kept more than 5 minutes at one place
Doctor :  
so every sunday you give him a warm oil massage
Doctor :   are you there
Doctor :  
are you there
User :   yes
Doctor :   is there any thing i can help you with
Doctor :  
are you there
User :   yes
User :   i wish to have a chat with a surgical oncologist
User :   if possible
User :   its regarding a complaint for my mom in law
User :   hello
Doctor :   are you back?
Doctor :  
are you with me?
User :   yes
User :   there was some problem with the chat window
Doctor :   ok
Doctor :  
from your side?
User :   dont knw
User :   anwywys.
Doctor :   ok

User :   is there an surgical oncologist on board?
User :   i wish to discuss the case of my mom-in-law
User :   who was diagnosed with duct cell carcinoma
Doctor :  
I am a general practitioner, i will transfer to surgical oncologist if neede
Doctor :  
*needed
Doctor :  
is it ok?
User :   if you can help with a the latest operative/non-operative procedures for duct cell carcinoma which is at its nascent stage
User :   then its not needed to be transferred to the oncologist
Doctor :   you mean duct cell carcinoma of the breast?

User :   yes
User :   thats correct
Doctor :   ok
Doctor :   was biopsy done?
User :   yes
Doctor :   do you have report with you now?
User :   mammography/biopsy/FNAC
User :   yes i hav it
Doctor :  
plz type the impression, I want to know the extent of the disease especially the number and location of the lymph nodes which are involved '
User :   wat do u want from that?
User :   ok..
User :   gimme a second
Doctor :  
ok
User :   do u want the cytology report?
User :   i mean the guided FNAC report details
Doctor :  
first start from mammography
User :   k
User :   mammography impression: Doctor :  
ok
User :   Birads Parenchymal Density pattern 1, spiculated radioopaque hypoechoic lesion with increased vascularity in the superolateral quadrant of left breast-highly suggestive of malignancy
User :   ACR BI RADS Category - 5
User :   FNAC has been performed from the lesion
Doctor :  
ok
User :   the lesion measures 1.9 X 1.2 cms and is showing increased vascularity
Doctor :  
ok
User :   now do u also want the cytology report impressions?
Doctor :  
yes
User :   Microscopic Findings: Cellular smears show dyscohesive clusters and discrete oval cells with hyperchromatic nuclei, moderate amounts of cyctoplasm. Few cellls show prominent nuclei. There is moderate anisonucleosis. Few miotic figures are discerned. Red cells are seen in the background.
User :   Impression: Carcinoma Breast - morphology suggestive of duct cell carcinoma
Doctor :   ok

Doctor :  
i understood the reports
User :   ok
Doctor :  
the tumor is not very big
User :   yes
Doctor :  
i want to know few details regarding her symptoms
User :   ok
User :   please ask
Doctor :  
is the tumor mass movable or is fixed
Doctor :  
?
User :   fixed
Doctor :   fixex to the bones behind the breast or to the breast ?
Doctor :  
*fixed
User :   breast
Doctor :  
had she been examined by the oncologist?
Doctor :  
previously
User :   yes
User :   ofcourse we consulted a surgical oncologist
Doctor :  
did he mentioned that lymphnodes are also involved?
User :   we have got the other tests done as well
Doctor :  
which tests?
User :   the mammo report mentions this. : moderate volume of left axillary lymph node noted
User :   dont knw whther that means if the lymphnodes are involved
Doctor :   i have read the report I wanted to know if he had said clinically or not?

User :   the other test we hav got done are 2d echo/ecg/99mdp bone scan/liver function test/abdomen ultrasound/chest x ray/
User :   based on these above reports the doctor said it has not spread to other areas...
User :   and its local
Doctor :  
ok, regarding bone scan were there any lesions?
User :   no
Doctor :  
can you type the impression of the bone scan?
User :   Impression: Normal Bone Scan
Doctor :  
ok
User :   its reads that...'no focal hot or cold spot detected anywhere in the entire skeleton
Doctor :  
ok
Doctor :  
In my opinion
Doctor :  
as the tumor mass is small therefore the ideal approach should be to go for the surgery first and after that chemotherapy
Doctor :  
once the lesion of the surgery heals
User :   yes...
Doctor :  
depending on the position of the tumor the surgeon can go for the quadrant mastectomy
User :   ok...
Doctor :  
if the tumor had spread in more than one quadrant and if it had involved the lymphnodes also then it will require complete mastectomy
User :   but cant the surgical procedure..i.e. whether lumpectomy/matectomy cant be determined before the the surgical procedure is being performed?
Doctor :  
along with the excision of the involved lymphnodes also
Doctor :  
it is very difficult to determine previously only
User :   ok
User :   i was reading some information abt new methods of removing the tumors..
Doctor :   like?
User :   eg: laser based heat raditiaon/ cryofreezeing
User :   may not be the exact terminology
Doctor :  
these are not yet established methods
Doctor :  
and are under experimental phases only
Doctor :  
they are advised only in those cases in which the excision of the tumor is not possible
Doctor :  
at present
User :   ok
Doctor :  
may be in future they may take over
Doctor :  
even there may be very few specialists who had done the procedures
User :   k
User :   if you have an idea where these procedures can be performed in india..if possible in hyderabad in india
Doctor :  
i will need to check if they are performed in india
User :   ok
Doctor :   but why do you want to go for those procedures'

Doctor :  
they are still in experimental phase
Doctor :  
and at present only those patients are advised to go for them who are relly inoperable
Doctor :  
*really
Doctor :  
your mother in law had a very small tumor
User :   if there are advanced procedures available which coz minimal damage to the surrouinding cell/ tissues...then we thought we can prefer them
User :   since it is a small tumor
User :   ofcourse we definetely want to rule out the possibility of it resurfacing or spreading
Doctor :   i will advice you something, plz try to understand that
Doctor :   it is good to opt for the latest technology for the diagnosis
Doctor :  
but in case of treatment
Doctor :  
there even if the technology is good
Doctor :  
we dont have the supporting data that what will happen after 5 years as these are new techniques
Doctor :  
did you got my point?
User :   yes..
User :   since you mentioned that they are undefoing clinical trials
Doctor :  
there are a fair chances of the tumor to grow again or it is better called relapse. As the treatment options you are talking about are new, therefore we dont know that after treating with them will there be any relapse or not. If there are chances of any relapse then after how many years?
Doctor :  
there are many questions related to these techniques'
Doctor :  
which need to be answered
User :   ok..
Doctor :  
these all techniques should be tried by those who really dont have any other treatment option left
Doctor :  
as her tumor is small why do you want to take risk
User :   hmm...ok..what you say makes sense
Doctor :   remove it as much as possible

Doctor :  
there is a rule in surgical oncology
Doctor :  
more harshly and widely the tumor is removed the less are the chances of the relapse
Doctor :  
so go for extensive removal of the tisssue
Doctor :  
dont worry about the surrounding tissues
Doctor :  
they will heal up in few days
User :   ok
Doctor :  
then again reconstruction surgery can be performed
Doctor :  
but by doing so the chances of relapse will be very less
User :   okay
User :   also can you help me some guidance on alternative treatements and therapies
User :   heard about wheat grass therapy
Doctor :   i dont know if the wheat grass will help or not

Doctor :  
there is no data supporting
User :   ok
Doctor :   all these things will be available on the internet
Doctor :  
and they will ask for a good amount of money
Doctor :  
no reliability
User :   :)
Doctor :  
i will advice you to go for the surgery
User :   but any post operative care???
Doctor :  
yes
User :   my mom-in-law is diabetic and also hyper tension
Doctor :   she will require a good coverage of the antibiotic
Doctor :  
dont worry
User :   ok
Doctor :  
all you need to take care is good sugar management
Doctor :  
and antibiotic cover
User :   ok
Doctor :  
which the surgeon will take care
Doctor :  
after 3-4 weeks of the surgery
Doctor :  
chemotherapy can be started
User :   how often after the surgery should we get the other tests dones?
Doctor :  
and it is required
User :   and wat tests do u recommend?
Doctor :   initially she will require blood sugar management very day
Doctor :  
*every
Doctor :  
Blood count will be perfoirmed
Doctor :  
*performed
Doctor :  
no need to go for mammogram
Doctor :  
you should go for the detailed biopsy of the tumor tissue
Doctor :  
and ER, PR and HER2NEU examination of the blocks of the tissue
Doctor :  
the above mentioned tests are necessary
Doctor :  
for further management
Doctor :  
Plz go for chemotherapy with medical oncologist
Doctor :  
after 3-4 weeks of the surgery
User :   ok
Doctor :   if both the treatment are taken together then the chances of relapse in 5 years are less than 50%

User :   how abt whole body PET /bone scan/liver function test/chest x ray/abdomen ultrasound..and how often these should be performed?
Doctor :   PET scan you should go just before starting the chemotherapy

Doctor :  
chest X-ray the, USG, LFT they will perform as and when needed
Doctor :  
there is no specific recommendation
User :   was also concerned about post operative stage..
User :   do we need to get these tests done periodically?
Doctor :   bone scan is not required in near future

Doctor :  
once the oncologist will start
Doctor :  
on chemotherapy
Doctor :  
it will take some 4-5 months
Doctor :  
after the chemotherapy you should go for mammography
Doctor :  
to see if any residual tissue is there or no
Doctor :   i mean tumor tissue
User :   ok
Doctor :  
did you follow?
User :   yes
User :   thanks a lot for the info...and advise
User :   but before we end this chat..wanted to understand the urgency of the operations
Doctor :  
ok
Doctor :  
it is better to go for it as soon as possible
Doctor :   because if the tumor will spread once to bones or blood or lymphnode then it will be a problem
Doctor :   so it is very urgent

Doctor :  
you should go for it as soon as possible
User :   i have scheduled for the surgery this wednesday
Doctor :  
ok
Doctor :  
it is good
User :   ya...thanks a lot doctor...
User :   may i knw your name?
Doctor :  
User :   your an oncologist?
Doctor :  
I am General Practitioner but have experience of oncology for 2-3 years
User :   ok
Doctor :  
Is there any thing else I can help you with?
User :   no...that would be all
User :   thanks a lot for your advise and guidance
Doctor :  
Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
User :   hi doctor
Doctor :   Hi
User :   hello this is AAAAAAA
Doctor :  
Ok
User :   can i get your name pls
Doctor :  
Proceed with your Q
User :   can a have a solution for hair fall, dandruf
Doctor :  
solution is there for hair fall and dandruff
Doctor :  
explain to me the symptoms your suffering
User :   greaying of hair, hair fall & dandruff is the problem
User :   could be bcoz of pollution, stress
User :   or even bad diet
Doctor :  
could be cos of improper attention given to hair care also
User :   k
User :   can i get a solution for this pls
Doctor :   since when you are facing this problem

User :   for last 2 to 3 years & its for my husband
User :   helloooo
User :   ru busy??
Doctor :   did he consult any doctor for this

User :   no
Doctor :  
yes i am also responding to the other patient Q
User :   but getting oil massage done when ever he finds time
User :   k
Doctor :   what home remedies you have tried

User :   oil massage & apply AAAAAAA powder
User :   in AAAAAAA powder added curd, black pepper
User :   im not able to make out if its bcoz of dry skin or oily skin
Doctor :   people with oily skin have more of this dandruff problem

Doctor :   is he oily skinned types or dry skin types
User :   guess oily
Doctor :   ok
Doctor :  
any other information you need to share
User :   thats all
Doctor :   based on your medical history i would first suggest you to visit a dermatologist
User :   ok
Doctor :   dandruff is because of inefficient hair care
User :   is that all
User :   k
Doctor :  
for now i would suggest you to use scalp shampoo twice in a week
Doctor :  
shampoo name is SCALP
User :   k
Doctor :  
the shampoo application is also a techenique
Doctor :  
it should be applied to the skin of head and root of hairs. thorough massage should be done to the head
Doctor :  
and left for 5 minutes
User :   k
Doctor :  
then wash with luke warm watter
Doctor :  
if the dandruff is very severe
Doctor :  
than it can be used every alternate days
Doctor :  
otherwise twice a week is enough
Doctor :  
if you are using hair conditioner
Doctor :  
than it should not be applied to skin and hair route
User :   u mean the conditioner should not be used
Doctor :  
it should be applied leaving 0.5 cms from the root of hair
User :   while using the scalp shampoo
Doctor :  
i did not say so
User :   k
Doctor :  
i told not to apply conditioner to the skin and hair root.
User :   does oil massage n AAAAAAA help or can he stopped
Doctor :  
i dont know about heena. as i am allopathic doctor
Doctor :  
but oil massage do help
User :   oh ok
User :   ok, is that all or anything else needs to be noted
Doctor :   try this and consult your dermatologist.
User :   ok now can i ask for a solution for my hair problem
Doctor :   yes proceed

User :   my hair is by birth thin
User :   is there a solution to increase the density
Doctor :   increase density?
Doctor :  
you mean by drugs or surgery
User :   either ways
Doctor :   there is no medication to increase the density

User :   i feel its hereditary as my brother almost loss the entire hair on his head
Doctor :   surgically hair transplant can be done to increase the density
User :   he has got bald head at an age of 27
User :   do u suggest good institutes at hyderabad n the expenditure involved
Doctor :  
it will be decided by the dermatologist
User :   ok
Doctor :   cost you need to talk to the dermatologist who is performing the procedure as it depends on hospitals and procedure
Doctor :   AAAAAAA skin clinic is ideal as it deals only with hair and skin
Doctor :   is there anything else i can help you with

Doctor :   I have to close this window since there is no response from your side, we are available 24/7 please get back to us if you need further medical advice.

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