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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Treated with Hormonal therapy and bisphosphate for breast cancer. Having hot chills, dry mouth and urge for urination.

Answered by
Dr.
Dr. Robert Galamaga

Oncologist

Practicing since :2002

Answered : 2638 Questions

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Posted on Thu, 27 Jun 2013 in Cancer
Question: Hi, My mother is being treated with Hormonal therapy and bisphosphate for metastatic breast cancer with spine mets. Recently she is experiencing hot chills (like high fever) with dry mouth and frequent urge for urination. Her USG is normal, blood and urine test reports are normal. Although gynac feels that there is a lower UTI but it has not reflected in blood and urine test? What could be this, could this be hypocalcemia, her blood calcium is close 12.
doctor
Answered by Dr. Robert Galamaga 2 hours later
Hello and thank you for sending your question.

This is a very good question and I will work on providing you with some information and recommendations. It is possible that electric light abnormalities or dehydration could be causing some of her symptoms. This can be easily checked with laboratory testing. Also if the urinalysis does not show any evidence of bacteria then treatment with antibiotics would not be indicated as there does not appear to be any hormonal medication is what may be causing her symptoms. There are multiple different medications within the class of hormonal therapy for her so that if she is not able to tolerate this particular medication she may discuss switching to an alternative with her primary oncologist. These medications have multiple side effects and it is certainly possible that this again maybe why she is not feeling well among other things including the fact that she has active metastatic breast cancer.

It appears that her oncologist has chosen a very good therapy for what she is dealing with at this point. As I mentioned it may be a consideration to change to alternative hormonal therapy to see if she's able to better tolerate that.

Thank you again for sending your question. Please let me know if you have any additional specific concerns.

Sincerely,

Dr. Galamaga


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 1 hour later
Thank you Dr. XXXXXXX Would you see any neurological factors associated with our case, because of hot chills and fever like symptoms? As I said bone mets are a few months old and my mother has been on Tamoxifen since then. And, these symptoms are recent like last 7-8 days.
doctor
Answered by Dr. Robert Galamaga 7 minutes later
Hello again,

I apologize for the typographical error in my first response. I meant to say electrolyte and not electric light. The autocorrect feature triggered that I believe.

Regarding the neurological symptoms this is not typically seen with hormone therapy that I am aware of.

It may be possible that the activity of the tamoxifen is causing tumor cells to die which could trigger fever or chills at times.

Is there any reason in particular why the oncologist advised tamoxifen and not aromatase inhibitor?

Thanks again,

Dr Galamaga
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 6 minutes later
I guess I remember my mother continuing with Aromatase inhibitor (arimidex) after mastectomy and chemo for 4 yrs but then she had terrible side effects and then she stopped taking the medication and unfortunately 4-6 months back spine mets appeared. Maybe with that history, our oncologist suggested tamoxifen and bisphosphate?
doctor
Answered by Dr. Robert Galamaga 23 hours later
Hello and thank you for the additional information.

It is possible that if she could not tolerate the medication this is why it was switched to tamoxifen. I would make sure that you talk to the oncologist to see if they might recommend using a different aroma taste inhibitor Because we do have three of these medications available right now and sometimes women are able to tolerate one better than the other.

I absolutely Agree with the use of the bisphosphonate. This will help to maintain the strength of her bones as well as limit progression of metastatic disease.

The tamoxifen will also serve as good therapy to limit progression of the cancer an hopefully will lead to shrinkage of the deposits of metastatic cells.

Thank you again for the question. Please let me know if there are any additional specific concerns.

Dr Galamaga

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 17 minutes later
Thank you so much Dr. XXXXXXX appreciate your response. I am glad that you are also finding current treatment plan appropriate.

One thing I forgot to mention is my mother is diabetic as well but her sugar is well controlled on diet. Could you please explain or let me know how worrisome it is to have her blood calcium level 12? Is it normal to have this level? Would you recommend any additional diagnostic tests? We have already done with USG, blood and urine analysis and all these appear to be normal.
doctor
Answered by Dr. Robert Galamaga 7 hours later
The calcium level is something that should not be ignored. It is elevated because of the cancer cells causing breakdown of bone. The hope is that the tamoxifen will decrease the activity of the cancer cells and that the bisphosphanates will take some of that excess calcium and use it to strengthen the bones.

The calcium needs to be followed closely to make sure the trend is going in the right direction. The calcium level idealy should be below 10. I am not sure which medication the oncologist is using bu we would consider Zometa or Xgeva as effective agents in this setting.

No additional testing would be recommended in this case.

Thanks once again,

Please let me know if I can be of any additional assistance.

Dr. Galamaga
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 10 hours later
Hi Dr. XXXXXXX

We have had a bone scan today. I have uploaded recent the report for your review. This was long pending as four months back we just did brain and spine CT and her oncologist suggested us to get one.

Current symptoms (apart from mentioned above)- my mother has is a mild headache, feels like common cold. This has been for last 7 days. We consulted with ENT physician and he found everything normal as far as ENT is concerned.

Intermittent symptoms- nausea, metallic taste and hot flushes.

Would you still recommend us to continue the same treatment (Tamoxifen and bisphosphanates). I would also like to mention that during the first diagnosis (6.5 yrs back), she did have mets but these are new. Old mets went off after chemo and radio therapy.
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Follow up: Dr. Robert Galamaga 1 hour later
One more point I must mention, 4 months back when we did Tumor markers, It was 172 and 15 days back it was 93. Bisphosphanates currently prescribed is Blaztere-Zoledronic Acid which actually a generic of Zometa
doctor
Answered by Dr. Robert Galamaga 12 hours later
Hello,
Thanks for sending the report.

I am not surprised by the findings - it is consistent with what you have reported previously.

The calcium level should come down with continues Zometa treatment.

I believe the Zometa and tamoxifen are reasonable treatments to continue for now and represent good standard of care. This can be continued with periodic clinical followup exams with the oncologist.

The oncologist can also check the tumor markers again periodically to see if there is a trend in any one direction - hopefully the numbers will remain stable or will decline.

As for the headache - not sure of the exact cause. Perhaps seasonal allergies? Make sure she remains well hydrated and observe this for now. If she has not had an MRI of the brain this might be a consideration if headaches persist.

Thanks again for sharing your health concerns.

Dr. Galamaga
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 33 hours later
Thank you Dr. XXXXXXX for your suggestions. Yesterday we observed calcium level, it has come down to 10.03, I think that happened after the dose of bisphosphanates and steriod. Her head ache also stopped.

Sincerely,
XXXXXX
doctor
Answered by Dr. Robert Galamaga 40 minutes later
Thank you for the follow up.

I am very glad to see that the calcium is now close to normal. I would continue as the oncologist has suggested as her treatment doesn't appear to be quite optimal.

Please let us know in the future if we can be of any additional assistance.

Sincerely,

Dr. Galamaga
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 4 minutes later
Doctor you just said "I would continue as the oncologist has suggested as her treatment 'doesn't' appear to be quite optimal." Are you suggesting any change in the treatment plan?
doctor
Answered by Dr. Robert Galamaga 3 hours later
Hello again, this was a typographical error related to autocorrect. The treatment does appear to be quite optimal.

Apologize again for that. I would continue as the oncologist recommends.

Sincerely,

Dr Galamaga
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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