Question: This is my mother's 3rd relapse which has shown progression to her liver. She was diagnosed at stage 4 in 2006 with mets to her bones, lymph nodes and right breast. She then had 6 months taxotere, 12 rounds of radiotherapy, double mastectomy which completely removed her cancer. She was on hormonal therapy for one and half year, on arimedix but could not continue as she felt side effects were too much, especially bone pain and hot flashes.

Until XXXXXXX 2013 she did not show any clinical signs of cancer. XXXXXXX 2013 her progression was with extensive bone mets her spine, shoulder, hip, and couple of spots on skull. She then continued with tamoxifen and zolendronic acid. But since May 2013 she had many problems including frequent infections, acute renal failure and then recently in Feb 2014 pathological fracture to right hip joint. In May she diagnosed with progression to liver. That is when we started NAB paclitaxel chemo, she showed significant improvement right after first cycle, tumor markers dropped more than 60%, after 2nd cycle liver mets were not detectable on USG. Now after 3rd cycle she is suffering with server leg pain, especially calves and thighs to some extent. She has been diabetic but never had leg pain like this before. She is also vitamin D deficient which we have started additionally. She is also persistently having rectal pain, feel like she will have bowl movement all the time. I suppose that is because of paclitaxel. Please advise.

My mother had the PET CT scan, please find attached Pet Scan Report 27 Aug 2014.pdf . I think she responded well to first three cycles. She has given break and will start the 4th cycle with single dose than 3 weekly doses.

Unfortunately, her rectal pain is still there. She is no longer constipated We have had Gastrointestinologist investigation and that came out clear. She did not have any fever episode since last 2-3 weeks so I guess it cannot be infection. She has been having this rectal pain since last 2 weeks, could this be because of paclitaxel neuropathy? Her oncologist doesn't believe so. Neurologist is suggesting a nerve irritation but no one is very sure of that. She did have MRI 3 weeks back there was no indication of nerve compression. Can this be pudendal neuralgia? We feel like lost as my mother is continue to be in discomfort and we are not able to find the reason for the persistent rectal pain. She did have similar pain after first cycle but that did not last more than 7 days.

Thank you Doctor.

She had been treated for abscess with 6 weeks of antibiotics. Her blood lab has been stable and normal since last 3 weeks, with no redness or numbness at the specific area of abscess. She doesn't even have the pain she had before antibiotic treatment. Do you still think this could be related abscess? Would you suggest any further investigations? She does have leg pain but that is in both the legs.
Also, I would also like to ask about her leg pain. The severity of leg pain has gone up after 3rd cycle of paclitaxel and as she is on break, even after 3 weeks since last paclitaxel weekly dose she has the leg pain. How long the leg pain persists?

She has been on weekly dose until 3rd cycle but now her oncologist wants her to shift on once in 3 weekly lower dose of 175mg/m2, is that reasonable plan considering her rectal pain and leg pain issue?

Thanks again for your help.

Thank you doctor, do you mean to say that pain will continue and may worsen even with one 3 weekly dose of 175 mg/m2?
I mean both the rectal and leg pain. Is this reversible once all the cycles are complete and if so how long does it take to recover?

Thank you Doctor. She is on lyrica and Amitone 10. She feels comfortable only when in sleep otherwise pain is quite persistent. About Abscess, USG did not show any pus. Her today's HB is 8.7, platelet 120,000 (almost unchanged since last 2 weeks ) and WBC is in normal range. Would you now attribute the rectal and leg pain to paclitaxel? Anything else we can do to manage pain?
Also, considering the last weekly dose that she had three weeks back, is it worrisome to have platelets still below normal level. She was to start her full dose tomorrow but her doctor postponed it for another week saying low platelets.

Hello Doctor,

My mother had a very high grade fever day before yesterday night, she was then treated with IV antibiotics for two days and there was no fever episode since day before yesterday morning. But, today we had her blood culture report which says fungal infection. Her doctor has advised to start antifungals and stop antibiotics. She has been on central line catheter for last 4 weeks. We are not sure who is the culprit here for this infection but how do we go from here? Do we need to stop the next chemo cycle until this clears off?

Also does this fungal infection may have anything to do with her rectal pain?
Just to clarify she had fever 48 hours back and after the start of antibiotic fever did not return.