Dear Doctors,
I need some advise/opinion on my father's current situation.
Metastatic adenocarcinoma, ddx May 2011. Been fairly stable, with mild progression from time to time, intermittent treatment with Alimta. Been on a break since May 2013, because scans were stable. Always had a metastasis in S1 body, been getting some back pain for the past 3-4 months, and a scan in Sept 2013 showed progression in S1 met. Had 2 weeks of radio, which was completed 4 weeks ago. 2 weeks ago, developed radiating pain into posterior thigh, and right lateral leg, typical L5 nerve root. Within a few days, was unable to weightbear/walk, had no pain on sitting or lying. I am an osteopath, did a neuro assessment all was fine, but anytime he tried to get up strong pain into the right lateral calf. After a few days, he went to the hospital to try and manage this. They did an x-ray/ct to exclude fracture etc. There was no change to the previous ct scan, no fractures. He was give Lyrica, Endon, did not help much, after 3 days, he was given Dexamethasone, and that afternoon he was walking. Went home with all the same medication about 1 week ago, slowly been deteriorating, and last night had a lot of pain in right lateral calf again. Went to hospital again today.
I spoke to the doctor on duty today, and she thinks its referred pain from the S1 met, and will add a Ketamine IV infusion, for pain control. I have suggested a L5 nerve root sheath injection, or epidural injection, but she said she doesnt think its necessary.
From my experience, these symptoms are typical L5 nerve root, whether its radiation damage, or local oedema, I dont know, but in my opinion, this doesnt look like S1 bone pain referral ( no pain on rest, full rom supine, or sitting, only weight bearing )
I would really appreciate an opinion from one of the radiation oncologist on this situation.
Is this radiation damage? Bone pain?, Any suggestions for management, and prognosis? The dont want to start chemo, till symptoms settl
Post-Radiation Complications/Nerve damage - 1260605
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Reply # - November 19, 2013, 08:26 PM
Reply To: Post – Radiation Complications/Nerve damage
I haven't seen or heard of anything like this as post-radiation damage. To be honest, I can't really speculate what's going on, mostly because I just don't have a good answer. It doesn't sound like anything I'd expect to see, and I'd seek scans like an MRI to get a better sense of what might be happening.
Good luck.
-Dr. West
Reply # - November 20, 2013, 01:45 PM
Reply To: Post-Radiation Complications/Nerve damage
Thank you Dr. West,
I have been asking for MRI, but they are reluctant to do it as yet (cost? maybe). We may try to get an MRI privately, as his condition is not improving, even with considerable amount of pain medication.
Felix