My mother was diagnosed with grade 4 breast cancer last month. She had abscess drainage from the left breast. Now, she is taking Femara 2.5 and Zometa 4.0 mg. After the next day, she became sick with fever, weakness, and lost consciousness for 30 seconds. We took her to the emergency immediately. They did some tests and she has a blood sugar level of 331 mg/dL, PO2 of 18.4 kPa, PCO2 of 26.8 mmHg. Now she is fine and taking treatment. I need your second opinion. I am attaching her reports and please advise.
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I have gone through the reports (attachment removed to protect patient identity). She has metastatic inflammatory breast cancer with lung and bony metastasis. She needs to control diabetes by doing exercise, diet, and medication. She needs to consult an endocrinologist soon. Replace Zometa (Zoledronic acid) with Denosumab as her kidney can get affected with diabetic nephropathy. Denosumab is effective and safe for kidneys. Along with Denosumab. she needs to take calcium and vitamin D supplements. Breast abscess can recur even after draining it and the doctor should examine it at every visit. Fever can occur due to reaccumulation of the abscess.
Regarding episodes of temporary loss of consciousness, it can be due to a sudden drop of calcium after taking Zometa or it can be due to some brain pathology. If she develops similar symptoms, then you need to do an MRI (magnetic resonance imaging) brain with contrast. She has multilevel disc disease with thecal compression. She needs a neurosurgical review urgently. Regarding the treatment of breast cancer, she should continue taking Letrozole. She needs to take Palbociclib along with it or she should take Letrozole along with Fulvestrant. Try to continue taking it for two to three months followed by CT (computed tomography) scan for reassessment.
Thank you doctor,
Regarding diabetes, she has consulted the doctor and her sugar levels are fine. We are trying to replace Zometa with Denosumab according to your advice. Please mention its dosage and duration of taking it. Regarding loss of consciousness, she seems to be fine but I will do an MRI brain soon and send you reports soon. We are going to have a neurosurgical review next week. Please mention the dosage and timing of taking Palbociclib along with Femara 2.5 mg. Please mention some supplements and diet needed for the health condition. Do these medications cause any side effects such as mouth sores, tiredness, loss of appetite, weakness? If it causes any side effects, how to overcome it?
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The dosage of Denosumab is 120 mg and take it for four weeks. It can cause a decrease in serum calcium levels. So before taking it, you need to check your mother's calcium levels and KFT (kidney function test). She should take calcium and vitamin D supplements. The dosage of Palbociclib is 125 mg orally once daily with food for 21 days and stop taking it for one week. Then you can repeat it for another 21 days. It can cause a decrease in the white blood cells, nausea, vomiting, diarrhea, mouth sores, low energy, and sometimes it can cause changes in ECG (electrocardiogram). Some patients can tolerate it.
But the dose can be decreased to 100 mg or 75 mg if there are any side effects. Then consult the doctor immediately. She needs to do CBC (complete blood count) and blood chemistry before each cycle or for every three weeks. If Palbociclib is not available, then it can be replaced with Ribociclib 600 mg. Take it daily for 21 days. The side effects are the same as Palbociclib. She should take low fatty, low oily, and low spicy foods. She should not take salads, yogurt, hot foods, and outside foods.
She should take only home-cooked foods. To prevent sore throat, she needs to do gargling with saltwater or with mouth wash Chlorhex. Maintain good oral hygiene. Use a soft brush to clean the teeth. For appetite, she can take Cyproheptadine 4 mg twice daily. Have a walk daily. Take tablet Panax ginseng 200 mg twice daily for three weeks. Take bath daily. It is difficult for me to provide suggestions without examining the patient physically. So it is good to consult a local oncologist soon.
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