Hi, I am new here and need some information

khemraj · New User Joined: 17 Sep 2009 Posts: 6 Location: Delhi

My father is 65 and was diagnosed with adenocarcinoma of the lung with pleural and liver metastases at the end of July 09. He had been having symptoms (non resolving rt. sided pleural effusion and dyspnoea) for about 6 months that were attributed to TB. However, biopsy and scans revealed adeno. Since then, he has been on palliative chemotherapy (Cisplatin and Docetaxel) and has received one complete cycle (broken up into three weekly sub-cycles) and the first dose of the second cycle. In between, he received two shots of Neukine for low WBC.

Since the second cycle has begun, he has become very anaemic and received Inj Epo for it. Also, he has been having loose motions for about 7 days, not diarrhea, but just that his stools are watery. The doctors are pumping him with antibiotics and Loperamide but they are not helping. I am clueless about why this is happening and am seeking information on whether this is happening because of the Liver damage. Should I see a liver specialist for this or just wait for the chemo to work? Also, the pl. effusion carries on, and we are desperate that at least that should resolve. Can anyone tell me how long the chemo will take to affect tha effusion?

All help will be much appreciated,
Thank you

pbj11 · Site Admin Joined: 12 May 2007 Posts: 2404

Hello and welcome to the forums,

I'm sorry to hear this news about your Dad. Honestly it all sounds pretty normal for someone going through chemotherapy. Some people do get diarrhea as a result of the chemo and with him getting segmented doses, he doesn't get that "break time" in-between cycles. The side effects will stay with him as a result of never really getting the usual three week break between cycles. Cisplatin is known to be a little harder on the body than Carboplatin, so they may end up switching out if he continues to have problems with the side-effects.

I'm surprised the Loperamide hasn't helped. Make sure the doctor is aware of the situation. Antibiotics can also cause diarrhea. Is he on them because his WBC is low?

He needs to stay super-hydrated during chemo treatments and all the more so if he is using the bathroom a lot. Make sure he's getting plenty of electrolytes in the fluid as this imbalance can be rough on his whole function and make him feel worse. Things like sports drinks or gatorade are good. Plenty of water too.

It really depends on how well the chemo shrinks the cancer as to how quickly the pleural effusion stops. Once the offending irritation (tumor) is reduced enough, then the effusion should slow down. If he has a heavy tumor burden, it might take awhile.

You're on the roller coaster of a lifetime with this cancer, but you'll notice patterns emerging of how it goes once he gets a few cycles under his belt. The one hard fast rule about lung cancer are there are NO hard fast rules.

Good luck and we're here to answer anything you need. Lots of very knowledgeable people are here who have or are walking this journey too.

PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

khemraj · New User Joined: 17 Sep 2009 Posts: 6 Location: Delhi

Dear PBJ,

Thank you for your heartening words and prompt reply.

Yes, he's been on antibiotics because his WBC counts were low. At one point the counts were almost critical. The weekly cycle is tremendous stress on the system; as you said, there is no time to recover. He gets shots for low counts and then when counts normalize the doctors zap the counts again. It really is hellish to watch.

He was on ICD and when the surgeon removed the drain, he left the hole open so that whenever there is excess fluid buildup the water just oozes out. It gives relief from the dyspnoea but it is really messy and panics the patient no end. But we are without choice in this matter, I guess.

All we can do is wait for the chemo to work as far as the effusion is concerned. Should we do the same for the liver metastases? Can a competent hepatologist help?

I m very glad I found this forum. It is impossible to face this alone.

Khemraj

pbj11 · Site Admin Joined: 12 May 2007 Posts: 2404

Hi again Khemraj,

I'm not quite understanding what an ICD really is. Sounds like they put drainage tubes in, but usually those stay in place and the family is instructed on how to do the actual draining at home and how to keep it clean so no infection starts. He doesn't just have a hole, does he? The options for pleural effusion are usually a drainage tube arrangement, permanent sealing of the pleural area done, typically with a talc substance, or thoracentesis (where a lung specialist runs a long needle-type instrument into the fluid and drains it as an outpatient procedure.)

The hope is that the chemo will address any of the metastatic cancer in the body, with the exception of brain mets. The oncologist and a lung specialist is usually all that is needed by a lung cancer patient. If he has radiation at some point, a radiation oncologist would be involved too.

I pray he gets through these treatments okay. Is there a specific reason why they are going with weekly treatments instead of the usual once every three weeks? Usually this is reserved for people who are deemed weakened and unable to handle the full dose.

It IS a horribly stressful time on loved ones as everyone feels so darn helpless. I understand your hurt at seeing your Dad in this condition. Are they monitoring his blood oxygen to make sure he has adequate levels?

Take care and keep us updated.

God bless,
PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

khemraj · New User Joined: 17 Sep 2009 Posts: 6 Location: Delhi

ICD is Inter Costal Drainage. The oncologists here advised us to get the tube removed because they felt there was danger of infection; he had been on it for some time. Also, my father’s prostate’s been acting up and he’s been catheterized for easy passage of urine. Two bags would have rendered him immobile. The onco-surgeon who removed the ICD told us that if he sealed the hole, the fluid build-up would cause dyspnoea and we had no idea how long the chemo would take to resolve the effusion. In hindsight it seems like a good decision, the only feasible decision, in fact. I have seen him going ten days without sleep because shortness of breath would just not let him sleep. Now we just need to take care that the wound is dressed regularly (twice a day) and prevent infection.

Yes, he was pluorodesed twice, once with talc and once with Bleomycin, both didn’t work. Now when the wound heals and if fluid builds up, the only option we’ll be left with is thoracentesis.

Yes, it was in view of his general condition that he’s being given segmented doses. He’s had symptoms for abt 4 mnths before diagnosis and that took a toll. I m glad doctors took that decision. A twenty-one day cycle would have pulverized him, I guess. He is anaemic and has some pedal oedema, but he’s mobile and fully functional, blood oxygen levels are OK.

Thanks for your help and god bless everyone on this forum and everyone battling this.

pbj11 · Site Admin Joined: 12 May 2007 Posts: 2404

Hi again khemraj,

I'm sorry the pleurodesis didn't work out. That was one avenue that my husband never wanted to pursue, so he had over 20 thoracentesis procedures done during his journey. Usually, when they install a drain system, they leave a capped tube in place and it can be drained as the build up of fluid occurs at home. We didn't go that route either, so maybe others can give you more insight into that process.

SOB (shortness of breath) is a horrible feeling and one that my husband fought all the time whether it was from tumors blocking his bronchial tubes or from the effusion.

I hope he shows some response to this therapy and starts getting strength back. Please keep us posted. We are here to help and support in any way we can.

God bless,
PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

khemraj · New User Joined: 17 Sep 2009 Posts: 6 Location: Delhi

We’re surprised that the procedure, done twice, didn’t work. Some fibrosis happened after the second pleuorodesis and the effusion reduced, but did not stop. Perhaps it’s the tumour load that causes fluid build up.

I am so sorry to hear about your husband. 20 thoracentesis procedures is a massive number, must have been so very difficult. I do hope that this difficult treatment regimen did him good and he managed to snatch his life back from this damn thing for a period of time.

We’re all praying that the chemo works and my dad, who’s staying with us now for the duration of the treatment, can go back home where he’s happiest.

Thank you for your support.

Khemraj

khemraj · New User Joined: 17 Sep 2009 Posts: 6 Location: Delhi

My father completed two full cycles of chemo on 01/10. Thankfully, the last two sessions haven't been the usual hell. Some nausea but he's up and about the day after. We've been referred to yet another pulmonologist regarding the condition of his chest but I am extremely doubtful of what he can do to help. The doctors transfused a unit of whole blood and the effect of that is almost dramatic. There were some reactions but now, a week later, his overall condition and outlook on life is much improved. Still waiting for the CIsplatin to reduce the effusion.

The docs have put him on a long-term course of Gefitinib. Is it effective?

Also, with the kind permission of forum members, I would like to share information that I believe is of great import to people fighting this disease in India. In Delhi, where I live, my father is being treated at the Delhi State Cancer Institute. This is a fully autonomous government body that is providing cutting edge medical oncology and radiation therapy facilities [u]at no cost[/u] to all comers. It is only nine years old and is not fully set up but has proved a god send for us. The doctors are extremely competent and very caring, despite the tremendous patient turnover, and by taking the entire financial burden off us has eased our life tremendously. At a time when treatment for cancer in India is enough to wipe out the finances of an entire family, DSCI has really been a miracle.

pbj11 · Site Admin Joined: 12 May 2007 Posts: 2404

Thanks for the update. I hope things continue to go reasonably well and that the effusion lessons.

Gefitinib is Iressa. It's a targeted drug that works best in patients whose tumors display the EGFR mutation. Tarceva is like the second generation of Iressa. Have they done these tests on a tumor sample to determine if he has the mutation? If a patient responds to this type of treatment, they can do well for long periods of time.

I wish him the best of luck with this new treatment.

Hugs,
PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

khemraj · New User Joined: 17 Sep 2009 Posts: 6 Location: Delhi

Hi,

Sorry about the long silence. Been fearsomely busy. Thank you for the good wishes. Iressa continues; how much difference it is making, we do not know yet. Lately, after the 18th, Dad's developed severe cough. He can't lie down because the cough starts up. Sleeping has become very difficult. He had this problem at the time of diagnosis in July and it went away on its own. The pulmonologist suspected endobronchial involvement behind the cough then but a endoscopic review showed that there was no bronchial involvement. The cough is very severe and productive. The doctors have put him on a codeine based cough syrup but it doesnt seem to be working. Can anything be done about the cough?

Thanks,

Khemraj

dano

Hello Khemraj
So sorry to hear what your father is going through. I was coughing badly before They found out I had Cancer and then after starting treatment and still coughing they discovered that I had blood clots in my lungs caused by the cancer. I was treated with Lovinox shots and the cough went away and breathing was much improved. The clots were not seen in previous CT scans because they were not looking for them. So they have to set the CT scanner up right to see them. A lot of good doctors missed that. Not sure this is what is causing your fathers cough but it's a thought.
Best of luck
Dan
_________________
55 year old male, Diagnosed Nov. 9,2007 with NSCLC IV with Mets to the lymphs and brain
Had full brain radiation treatment in Jan 08 treatments now every 4 weeks with Alimta, taking Lovenox for blood clots, Now working full time
http://cancerforums.net/viewtopic.php?t=9993

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