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Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome

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Psychiatrist
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hellow doctor..my mother is brain cancer pationt(gbm4), had surgery 7 months back..now she almost bed ridden.she compleatly dipending on dexamethazome (steroid)
Posted Wed, 30 Oct 2013 in Brain and Spine
 
 
Answered by Dr. Anjana Rao Kavoor 1 hour later
Brief Answer:
Dexamethasone is to decrease brain swelling.

Detailed Answer:
Hi,
Thanks for writing in to us.

I am sorry to hear that your mother is fighting brain cancer (GBM4) and is presently bedridden.

As you may be aware, GBM (glioblastoma multiforme) is an aggressive tumor and there are many factors on which the treatment of such a tumor depends. Treatment often includes surgery, radiation and chemotherapy. Surgery may not be able to treat the cancer completely. Surgery for such tumors is mainly to decrease the pressure of the tumor on the normal brain and in few lucky patients can even show significant improvement. It would be important to know if any recent CT scan or MRI scan has been done and the presence of any residual tumor.

Steroids like dexamethazone are given to stabilize the local effects of tumor like brain swelling. Steroids can continue and this will prevent any brain swelling due to remaining tumor if present.

I would suggest that you take care of your mother like a child and not allow her to develop bedsores on her body. Also try and keep her busy by talking to her and give her enough family support. Give attention to her diet and medications for pain. Do ask her regularly if she is having any problems.

Hope your query is answered.
Do write back in case of doubts.

God bless your mother.

Regards,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome 25 minutes later
thax for the reply dr..last qustion I could not complete and got posted inbetween..now the issue is thr is growth of tumor and we not going for another surgery due to her physical condition.dexamethazone around 12 to 16 mg she is on now and XXXXXXX pill, pantadac and some diuretic she taking.her legs and stomoch swolen ..and these days she complaining abt her stomuch pain a lot. and left eye and legs pain too (tumor is on left frontal).wondering if we can give her some relief from her stomuch and other pains..thank you..
 
 
Answered by Dr. Anjana Rao Kavoor 48 minutes later
Brief Answer:
Answer to complete query.

Detailed Answer:
Hi,
Thanks for writing in with an update.

As it may be expected, the aggressive nature of GBM4 does not allow the cancer to be removed completely even after a reasonably good surgery. As it is in frontal lobe the recurrent features are slowly appearing considering that 7 months are over following surgery.

Levipil (levetiracetam) is given to control any seizure or epileptic attacks. Pantodac is for decreasing acid formation in stomach. This will work for her gastritis related problems. Diuretic is given to control water retention in the body.

If she is having gastritis, I would suggest you give her small multiple feeds which are not very spicy. Do not keep her fasting for long. Pantodac must be taken at least 30 minutes for best effect.

If she is having body pain, please apply pain killer ointment. Giving her tablet for pain will increase stomach pain. Steroid is taking care of left eye pain. Change her position every two hours during the day as this will prevent development of bed sores and deep vein thrombosis.

Hope your query is answered.
Do write back in case of doubts.

God bless your mother.

Regards,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome 2 days later
hello dr following this regime is giving her some relief thank u .also, wanted to know till per day how much mg of decdak can we give her in this case , she is complaining of pain in her left eye and there seems to be an increased slurry while speaking.
 
 
Answered by Dr. Anjana Rao Kavoor 42 hours later
Brief Answer:
Appropriate dose is 16 mg dexamethasone

Detailed Answer:
Hi,
Thanks for writing in with a new query.

Dexamethasone is a steroid preparation and is given to patients to control the effects of brain tumor as in your mother.

Maximum dose given is 16 m dexamethasone per day and this should be able to control the brain swelling (edema) and nerve compression causing left eye pain.

The slurry speech and eye pain are due to secondary effects of brain tumor involving left frontal lobe.

Hope your query is answered.
Do write back in case of doubts.

God bless your mother.

Regards,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome 9 days later
one more question regarding my mother's condition, at this stage we are having to give her anema every 3 to 4
days, as she is unable to pass motion on her own and her stomach hurts after we give her Anema she feels relieved for two days. is this advisable or will cause more complication. also from last three days we are noticing white mucousy sticky liquid in her urine. please advise
 
 
Answered by Dr. Anjana Rao Kavoor 37 minutes later
Brief Answer:
Give oral laxatives and do urine culture please.

Detailed Answer:
Hi,
Thanks for writing in with a new query.

Enemas may need to be repeated several times to clear the bowel of hard impacted faeces; patients can then usually be maintained with regular oral laxatives. When rectal laxatives are required, an appropriate oral laxative should be prescribed at the same time. Once disimpaction occurs, the dose of oral laxative may need to be titrated with the aim of reaching a maintenance dose that prevents further faecal impaction. They should not, however, be part of the regular treatment of every cancer patient with constipation. Enemas are given to solve an emergency problem like fecal impaction and once that’s resolved, it is better to continue with oral laxatives.

The white sticky mucous appearance in urine may be a sign of infection. This needs urine culture and sensitivity and treatment with antibiotics if positive for infection. At the same time please see that she is taking enough water and fluids to prevent dehydration.

Hope your query is answered.
Do write back in case of doubts.

God bless your mother.

Regards,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome 8 days later
thanks for the replying.. right now she is little stable 'but she is finding it difficult to gulp the pills. she is on levipil ,pantadoc and dexamethazone mainly. my question ,is there any other form or smaller of these pills availble? and intra vain injections bacame very difficult be coz finding her vain become very painful process for her.. can we powder the pills or any other options?
 
 
Answered by Dr. Anjana Rao Kavoor 2 hours later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Hi,
You are welcome and thanks for writing back with an update.

There are syrups containing Levipil and dexamethasone and alternatives in oral form for pantodac.

1. Levipil Syrup is avaibable as 100 mg x 1 mL x 100ml (350 INR)
2. Pantodac is not to be powdered, else it will lose the action. You may ask your doctor to prescribe one of the many syrups containing antacids.
3. Dexamethasone Syrup is available as Decdak Syrup 50 mL.

Please confirm all medications with your doctor before giving them.

Hope your query is answered.
Do write back in case of doubts.

God bless your mother.

Regards,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome 36 hours later
Dear doctor, today she stopped eating. With great difficulty she could swallow two spoons of water. we tried to put her on iv saline but we could not find her vain so iv dint happen. And she says yes when we ask whether she feeling hungry. And she throws back whatever we try to feed her including water. Is there anything that we can do make her feel comfortble ??
 
 
Answered by Dr. Anjana Rao Kavoor 4 hours later
Brief Answer:
Please discuss Ryle's tube feeding with doctor.

Detailed Answer:
Hi XXXXX,
Thanks for writing in to us.

I have read your through your query in detail.
Your mother's situation appears to be a difficult one right now. It is difficult to sustain proper functioning of the human body without adequate nutrition. If veins are not visible, parenteral nutrition is also not feasible. One of the remaining choices available is Ryle's tube feeding. In this procedure a plastic tube is put into the stomach through the nose and nutrition can be provided through this. This tube insertion must be done by a trained person and they apply a little bit of local anaesthesia gel in the nostril to minimise the discomfort to the patient. I guess you should talk about this to your doctor. Without nutrition she will get dehydrated in a day and things can get worse for her.

Hope your query is answered.
Do write back in case of doubts.

God bless your mother.

Regards,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome 10 hours later
Thanks for guiding me through this.. she is on ryle's tube from this afternoon. And looks like she is feeling better .Now my question is from yesterday morning she didn't take any of her regular medicine 16mg of decdak and levipil, pantadac. Can we stop these medication? or we continue this medicine with ryles tube? is decdak water soluble? I managed to find levipil syrup, but couldn't find decdak syrup anywhere .. Your answers are great help all this while, thanks for that again..
 
 
Answered by Dr. Anjana Rao Kavoor 3 hours later
Brief Answer:
Decdak is water dispersible, please give medicines

Detailed Answer:
Hi XXXXX,
You are welcome and thanks for writing in to us.

It is good that you have started Ryle's tube feeding and she is feeling better.

You should continue to give her medications with Ryle's tube. Decdak is water soluble and each tablet can get dispersed in 10 ml of water and then given through Ryle's tube. Levipil as you know is available in syrup.

Hope your query is answered.
Do write back in case of doubts.

God bless your mother.

Regards,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome 2 days later
doctor, she is looking rest less from last night. can we give ultracet (which is proscribed by the surgeon long back ).if yes how to give with ryles tube?or is there any other medication to make her comfortable?
 
 
Answered by Dr. Anjana Rao Kavoor 8 hours later
Brief Answer:
Ultracet should not be crushed.

Detailed Answer:
Hi,
Thanks for writing in with an update.

Ultracet contains tramadol and paracetamol. It is a powerful painkiller. Crushing the tablet may release a higher quantity of medication. This can also aggravate the gastritis which is already present.

I would suggest that you ask your doctor and give intramuscular injection tramadol as and when necessary.

Hope this helps.
Do write back if you have further doubts.

God Bless your mom.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Brain cancer patient. had surgery. Bed ridden. Depending on dexamethazome 18 minutes later
thanks for the reply Dr.. we realized that there is mucus in her throat giving her uncomfort. she is at home and bedridden, do you think we can do something manage her mucus problem? she not able to cough ..
 
 
Answered by Dr. Anjana Rao Kavoor 13 hours later
Brief Answer:
Suction to be done

Detailed Answer:
Hi,
Thanks for your update.

The problem of mucus formation can be solved only by regular aspiration. Please talk to your doctor in this regard. There are medications to decrease secretions in throat but they can give rise ti dryness. If you know any anaesthesia specialist near your house then discussing with them will would be the best so that they can make a home visit in the event of an emergency.

God Bless your mom.

Regards,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
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