Nsclc squamous stage 4 relentless cough

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April 27, 2014 at 11:38 pm  #1263465    

sarahm

Unremitting cough
Klaas 63 former smoker, nsclc squamous now stage 4 diagnosed Oct 2012. Initially a mass rtl lower lobe + mediastinal lymph node involvement! then pericardial effusion and mets other lung. Treatment to date cisplatin/etoposide then carboplatin /gemcitabine. Latest scan shows progression, a mass in the pericardium, a met in the spleen and abnormal looking liver but no mets showing there. History of spiking temperatures pm 39.3 responding to paracetamol. Recently hospitalised in Tenerife left lung infection/pneumonia now cleared totally.

On chemo break at the moment as not strong enough at the moment.

Drugs 10 mg prednisone, beta blockers, sinfastine, metformin a phlegm breaker and acenocourmarol and seretide inhaler. Blood Hb 4.9 on Thurs received 2 units prbc. Feeling more energised, more apetite but still existing on food replacement drinks but now has no evening temperatures! (Steroids?)

During the day, he has one or two coughing bouts but at night it is now dreadful, last night we were up from 0100-0500 and woke again at 0630. I percuss his chest but that does not seem to be helping anymore. Any tips or advice would be very gratefully received.

Best wishes

Sarah

April 28, 2014 at 5:28 am  #1263467    
JimC Forum Moderator
JimC Forum Moderator

Hi Sarah,

In response to a similar question about nighttime coughing, Dr. West had this to say:

“My leading suspicion is that the coughing is related to positional changes at night. If there’s some increase in the size of a lymph node or the tumor, and it now presses against a nerve, that could trigger coughing when lying flat, not related directly to time of day. Another possibility is that fluid around the lung(s), called a pleural effusion, could accummulate more at night when lying flat, causing a cough. And fluid return in the veins from other parts of the body to the chest is increased when a person lies flat, so it’s possible that there’s a bit of fluid backup from the heart into the lungs with lying flat (some degree of heart failure, basically), but that wouldn’t be my leading thought.

Of course, this is all conjecture, and the most valuable thing will be to see what the scans show and take if from there.” – http://cancergrace.org/forums/index.php?topic=110.msg492#msg492

You might also want to review Dr. Harman’s post on managing cough: http://cancergrace.org/cancer-treatments/2009/05/09/managing-cough/

GRACE member certain spring had a few suggestions:

“My main advice for the night-time is not to sleep flat, but to put a couple of pillows under the mattress (if they’re on top of it, they will slide), so the person who is coughing has his/her torso elevated. Or get a foam rubber wedge cut to put under the mattress. There is nothing wrong with honey but I must confess that I personally would not want it combined with the onions! Some people find that Fishermen’s Friends (lozenges) suppress the cough reflex. If the cough is painful, I have found codeine linctus helpful, though it is heavy-duty and tends to make you sleepy.”http://cancergrace.org/lung/topic/managing-chronic-coughing-with-a-patient-diagnosed-with-nsclc/#post-12201

[Continued in the following post]

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

April 28, 2014 at 5:29 am  #1263468    
JimC Forum Moderator
JimC Forum Moderator

[continued from previous post]

In that same thread, Dr. Weiss added:

“Cough is one of the side effects that we sometimes have the most trouble managing. Pharmaceutically, we usually start with dextromethorphan (available over the counter) usually with guaifenasin to help thin the secretions (together, they’re guaifenasin-DM or robitussin-DM). By prescription, codeine helps many patients; again, it’s often given together with guaifenasin. For some patients, particularly those who describe their cough as starting with a tickle in their throat, tessalon perles can help (and what a cool name!) Finally, there are many home remedies and some work very well for people; I can’t imagine how sauteed onions and honey could ever do harm, so why not try?”

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

May 1, 2014 at 11:18 pm  #1263542    

sarahm

Hi Jim, thank you
We had a scan last week and does not show any pleural or pericardial effusion at the moment. Is it just co incidental that with prednisone prescription this has started, or could it be related to the fact he has just started taking temazepam as sleep was eluding him?

I will get some fishermen’s friends and see if they help. I will also try more pillows on the bed and look into getting a wedge pillow. Honey sounds fine but I don’t think we will subscribe to the honey and onion camp.

Thank you for taking the time to address my post. I just want to make sure he is as comfortable as possible and gets the best night’ sleep too.

Many thanks, any other advice/ ideas gratefully received

Sarah

May 2, 2014 at 9:18 am  #1263546    
catdander forum moderator
catdander forum moderator

Hi Sarah,

While reading this keep in mind that cough is a very common symptom with lots of causes not the least of which is nsclc…Looking through the National Institutes of Health’s (NIH) web page on prednisone I found cough to be a possible side effect and comes under the heading of side effects that are cause for concern and for which a call the the doctor is necessary. I didn’t find any type of interaction between the 2 drugs but that doesn’t mean it doesn’t exist, a call into the doc is never a bad idea when you’re worried about something or there’s a symptom that’s not been effectively addressed. And a cough is so very draining.

“Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
sore throat, fever, chills, cough, or other signs of infection
dry, hacking cough”

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601102.html

I hope this helps and best of luck to Klaas and you.
Janine

May 2, 2014 at 8:58 pm  #1263560    
Dr West
Dr West

I suspect that the cough is unrelated, but as noted in the comments above, a cough can be from many, many things. Your doctor may be able to provide a suggestion of the most likely cause, but we really can’t.

Good luck.

-Dr. West

May 3, 2014 at 1:34 am  #1263570    

sarahm

Hi, I wrote to his Dr, have not heard anything back though ….
Some good news, the coughing seems to have abated somewhat and the night sweats disappeared. We have the night back for sleeping!

A question … How long after giving/receiving packed red cell transfusions (2 units) would it be sensible to check the Hb level?
If starting with an Hb of 4.9, how much would the 2 units elevate the Hb level?

I am just wondering because K does have more energy but is still so tired and easily fatigued so thought maybe if his Hb level was restored that that might give him a big boost, energy wise and psychologically.
I do wish we could get something to rekindle his desire to eat too. He is existing on 4 bottles of nutridrink (1200 cals) some full fat milk and 1/2 lager!

Any help or advice gratefully received thank you so much for your help here.

May 3, 2014 at 8:45 am  #1263573    
Dr West
Dr West

I answered your questions on the other post thread. It’s not necessary to post the same questions in two places and tends to create confusion.

-Dr. West

May 3, 2014 at 8:54 am  #1263575    

sarahm

You did I am sorry, thank you very much. The first time he had a transfusion of 2 units his Hb was 5 then the second transfusion when his Hb was 4.9 at the end of the carboplatin/gemcitabine chemo. We then had the 6 wks rest which was when we had a rest from treatment and went to Tenerife. There, he had the bad lung infection, when we returned to NL, he had blood tests and another scan and his Hb was again 4.9 so he had the 2 units of red cells.

I did mention both megace and marinol to the dr and she said that she was not familiar with either of them. I have also read that some people claim that cannabis oil is effective in some measure in the treatment of lung cancer by targeting drug resistant cells and by stimulating appetite.

Our next scan and appt are the 2nd June, it is so difficult sitting waiting and not doing anything actively to fight the cancer. I do understand that Klaas needs to be stronger before round 3 chemo can be considered.

Thank you though so much for your time, it is so appreciated.

Best wishes for a wonderful weekend

Sarah

May 5, 2014 at 9:32 am  #1263613    
catdander forum moderator
catdander forum moderator

Sarah, I’m glad K and you are back to sleeping nights. : )

For appetite magace is a brand name for megestrol acetate and marinol the brand name for dronabinol. Perhaps out of the US these drugs are known by their generic name. I’d be surprised an oncologist isn’t aware of megestrol acetate.

Cannabis oil or tincture is well known to help some people with appetite, nausea, and pain relief but there are no clinical trials to prove this.

From most doctors’ experience none tend to work on people whose cancer isn’t controlled. Magace has always worked for my husband but his cancer, after diagnosis has been controlled.

All best,
Janine

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