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Suffer night sweats, hot flashes and extreme flushing. Treated with antibiotics. Breast cancer treatments. Guidance?

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Practicing since : 2007
Answered : 1279 Questions
Slammed into menopause with taxol (breast cancer treatments) October 2006. Symptoms for years, slowly dwindled to almost non-existent (hot flashes, night sweats, sweating). Past year 1/2 EXTREME flushing/VERY RED face/neck/chest/arms. Saw dermatologist, treated with 1 month of antibiotics/2xday allergy medication/medication on face/neck all to no avail. Worse in past several months, EXTREME redness/flushing. Had radiation in 2007 for 35 days, chemo for 16 weeks (4 chemo agents). Parathyroidectomy in 2002, after which some flushing/urticarial occurred. Seeing gynecologist in few weeks to talk over symptoms. Having issues with post-tamoxifen/aromasin usage (eye damage, extreme thickened uterine lining-negative for any cancer cells). Ideas on the extreme flushing/sweating especially on hairline, very embarrassing and wears me out daily. Thank you, XXXXXXX

For more info on the health query, after parathyroidectomy in 2002 (benign tumor/one gland removed), extreme rash all over body for about a year (saw dermatologists, rheumatologists, endocrinologists, allergists) also extreme pseudo-gout (pain in all joints) for about a year after surgery. Nothing showed except parvo. Treatment just for pain (naproxen).
Posted Sat, 27 Jul 2013 in Women's Health
Answered by Dr. Arif N Khan 2 hours later
Thank you for choosing XXXXXXX I am sorry for your symptoms. After detailed analysis of your query, what you are experiencing is MENOPAUSAL VASOMOTOR SYMPTOMS, and your endometrial thickness is due to tamoxifen treatment. I suggest you to go ahead with Non-hormonal treatment for these symptoms, as hormonal treatment is not recommended in your case. Treatment modalities which I recommend you are:
Lifestyle changes and complementary modalities, such as paced breathing, yoga, acupuncture and exercise. Dietary supplements, such as phytoestrogens,Evening Primrose Oil, black cohosh. And some of the drugs like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are found to be helpful. Kindly consult your doctor for full prescription.
Lastly, keep yourself cool, drink lot of fluids and water, eat lot of vegetables and fruits, decrease non-veg and spicy diet, Kindly relax and dont smoke/ drink.
I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow-ups. If you like my answers kindly rate it, and write a review as well. Please do not forget to accept it.
Thank you,
Wish you good health.
Dr Arif
You can consult me again directly through my profile

Above answer was peer-reviewed by
Follow-up: Suffer night sweats, hot flashes and extreme flushing. Treated with antibiotics. Breast cancer treatments. Guidance? 26 minutes later
Thank you for your quick response, Dr. XXXXXXX
Of course, the general answers I expected (diet, keeping cool).
Knowing that this is still menopausal vasomotor symptoms leads to just more questions, but at least answers why a dermatologist could not help with the symptoms.
I will bring all of this up to the gyn I am seeing August 5th.
My oncologist also states that having been thru radiation can cause damage that occurs years later. Also having issues with my parathyroidectomy/rash in 2002 doesn't help anything.
LOTS of issues...I don't expect that this was quite worth $35, as maybe a consultation with an OB/Oncologist would've been warranted (that's who I picked to answer the question)....I do appreciate your time.
If I could get a bit more of what menopausal vasomotor means (I also have daily migraines and take vascular constrictors, as narcotics/pain relievers do not help) from you or your fellow consultants, I'd appreciate it.

(I know actually that menopausal vasomotor means hot flashes, but I'm beyond all of that, those diminished a couple years ago) flashes now are EXTREME, if that's what they are, they have flared up again in extremes. It can happen in a very cold a/c room, anyplace that there is no air moving, and I get VERY VERY red/very flushed in the arms as well, sweating behind the hair and chest. I did not have it this severe the years that I went thru the menopausal symptoms (from chemo/slammed into it in one day starting taxol/gemzar Oct. 2006), symptoms started that very day, period ended that day since. Had a recurrence of period Xmas Day 2010, that's when we found the endometrial thickness (yes, from tamoxifen treatments). It's SO extreme now and with daily migraines, I'm very limited on what medications I can use (we cannot prevent them, hence we use vascular constrictors now for 20 years, never a problem though until cancer).
Thank you again ... XXXXXXX
Answered by Dr. Arif N Khan 5 hours later
I am sorry for not clarifying your doubts. This time i will try my best in answering your question. If you do not like my answers/ not satisfied I will be happy if you ask for refund of your money from the concerned persons.

These vasomotor symptoms are mainly due to lack of Oestrogen and along with that some changes in hypothalamic temperature regulating centre and the lack of estrogens alters this neurotransmitter activity, especially in the serotonergic and noradrenergic pathways(hence SSRI/SNRI are prescribed, kindly refer the above answer).
Hormone treatment is the best for managing these symptoms, but in your case as you are more prone to develop uterine (endometrial) carcinoma and history of cancer breast it is best avoided, as the risk is more compared to its benefits.
As it is totally unrelated to skin disorder, dermatologist wont be helpful to you.
The medication(relpax) which you are taking for migrane is a vasoconstrictor, which might in fact aggravate your vasomotor symptoms, hence I suggest you to consult a neurologist for the change in prescription.
I feel once your migraine is controlled with some other medications which does not have vasoconstrictor property, half of your problem is solved.
Recommended options for women with concerns or contraindications relating to estrogen-containing treatments include prescription containiing progestogens, venlafaxine, paroxetine, fluoxetine, or gabapentin (SSRI and SNRI which I described your early).
Wish you good health.
Dr Arif
You can consult me again directly through my profile

Above answer was peer-reviewed by
Follow-up: Suffer night sweats, hot flashes and extreme flushing. Treated with antibiotics. Breast cancer treatments. Guidance? 34 minutes later
Thank you, Dr. XXXXXXX
What you have written is actually what I have found online by looking up medications for non-hormonal treatment of severe menopausal symptoms (hot flashes, night sweats). 4 of the medications you listed I cannot take, as these are meds we've tried for the migraines, hence either relpax or dihydroergotamine (DHE) injections are the only solution for my daily migraines since 1993. I have always had very low blood pressure using these until the past year, and the flushing/rash started actually after the parathyroidectomy in 2002 along with rash/flushing/every joint pain. Vascular constrictors are the only pain relief that keeps me at a level '5' pain level daily. The migraines cannot be prevented, I've had the same pain since age 17. (Hence you can tell we've run the gamut with migraine prevention/treatments, I've been all over the country, right now best thing is just treatment of pain -- with vascular constrictors)....which I know aggravate the vascular system.
I believe there is one drug the FDA approved for non-hormonal treatment of severe menopause symptoms, and I will ask my GYN for a trial of that (see how it affects the migraine also, a big issue for me, as I'm disabled due to them).
Yes, I cannot have estrogen, as my cancer was estrogen-fed and I also had sentinel node disease.
You seem very knowledgeable, so I would not ask for a refund, I appreciate your input, as it correlates to my research, and my gynecologist recommended same SSRI/SNRIs that you have. I thank you for responding. I realize you don't know my full medical history to make a complete diagnosis. ~XXXXX
Answered by Dr. Arif N Khan 3 hours later
Thank you for the reply. I am happy that you completely know what you are having. I have found out following research modality treatments, hope this might help you in deciding further treatment:
1) Two antidepressants (low-dose paroxetine mesylate and desvenlafaxine succinate), a serotonin-2 antagonist (Esmirtazapine Org0000), and an alpha-2 XXXXXXX receptor binding agent (PD-0000)
Because of other adverse effects Paroxetine and Gabapentin are not recommended by FDA.
2)Acupuncture for vasomotor menopausal symptoms
I am sorry I could not give you much information. It is beyond my scope. I still advise you to ask some other expert in XXXXXXX who deal exclusively menopausal problems , without charging you extra money. Or else you can still go for refund. Thank you once again for choosing XXXXXXX I enjoyed solving your query.
Arif N Khan
Above answer was peer-reviewed by
Follow-up: Suffer night sweats, hot flashes and extreme flushing. Treated with antibiotics. Breast cancer treatments. Guidance? 7 hours later
Thank you again, Dr. Khan~
I was thinking of the FDA-approved drug Brisdelle, which as you state above about the Paxil, IS a low-dose paroxetine. Are you saying now that the FDA does NOT approve paroxetine for menopause symptoms (non-hormonal)?
The antidepressants you mentioned above, are they recommended by you and encouraged by the FDA? (I believe one is paroxetine and one is Effexor, which is the one drug I cannot take due to the migraines)...gabapentin is also one I cannot take anyway.
I'd never be able to get approval for acupuncture, and cannot afford it otherwise, but yes, that's a viable alternative.
I actually DID ask for a Gynecologist Oncologist to answer the question (Ask A Specialist) in the first place.
You have been very helpful, and no, I do not need a refund, just maybe a bit more clarification (WHAT meds above that you mentioned ARE recommended?), as I am going to call GYN's office and not wait til Aug. 5th for my appt. with her, ask to start using the Brisdelle (and inform her of the blood pressure/tachycardia meds I am on now), maybe a bit of change before I see her on Aug. 5th will happen, or maybe I cannot take it (very likely, but I don't think negatively first!).
So you HAVE helped, you've mentioned meds that can help non-hormone therapy for people who simply cannot go the estrogen route. Thank You.
Answered by Dr. Arif N Khan 41 minutes later
After checking the FDA website, I found that very recently in XXXXXXX end Brisdella is approved. So its a good news for you.
Other antidepressent which I have mentioned desvenlafaxine succinate is not approved by FDA.
I never got an opportunity to use these drugs on my patients, most of my menopausal symptoms have responded with hormonal treatment and isoflavones. I also advise all my menopausal patients EVENING PRIMROSE OIL CAPSULES.
Other drugs {serotonin-2 antagonist (Esmirtazapine Org0000), and an alpha-2 XXXXXXX receptor binding agent (PD-0000)} which I have mentioned are under trial basis/ under research settings.
Kindly give me your email Id, if I find any further information which interests you, I will mail you.
Wish you good health. All the best. May the almighty bless you and heal you. If you do not have any clarification you can close the discussion and kindly wire a review & rate my answer.
Dr Arif
You can consult me again directly through my profile
Above answer was peer-reviewed by
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