Bone metastases

dizzybuff38 · Posted: Sat Mar 26, 2005 3:40 pm Post subject: Bone metastases

Dr. Leo can you please advise me if alkaline phosphatase blood tests and normal x-ray of the hip can diagnose bone mets from breast cancer? I have had recurrent, at times , severe (in bed usually) pain in my left hip.
I have had alk phos test, x-ray (but not bone scan), both normal and am now undergoing weekly physiotherapy, which is painful. My physio tells me she can only rotate my left hip 50% compared to my right hip. I can walk okay, but have great difficult putting my left leg up on a foot stool and have pain especially in bed, and am awoken almost every hour with the pain. My annual breast cancer check-up has just been postponed by my local hospital (UK - socialised medicine - need I say more?) and I have other issues like a ropey kind of lump in the breast where I had the tumour, and a fall, concussion and blackout recently. Had to get paramedics and was hospitalised. Neurosurgeon in ER said I was okay, although I had a boggy haemotoma, whatever that is. No Catscan was done of my head. I am really worried about mets. I have also had Crohn's disease for some 35 years, most of them on steroids but now on methotrexate, and holding!!

History:

Dx invasive ductal carcinoma 2 cm, with associated intermediate grade DCIS, comedo and cribriform. Jan 2003. Stage and grade 2.
WLE and 8 sample nodes removal Fev 2003 - 2 nodes cancerous.
Total axillary removal March 2003, one more node positive. 3/18+
ER+ - PR and NEU2 not known.
6 x FEC and 46 grys rads with 2 boosters.
On Tamoxifen 3 months, then switched to Arimidex, a year now.

I will be grateful if you can shed some light on what I need to do.
Thank you, Liz.

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Liz

Sorry it took me a while to get here. Busy !

Anyway, your hip pain may be related to degenerative arthritis. The normal alklaline phosphatase and normal x-rays are good signs, but the test of choice is really a bone scan or a CT-scan. I don't know your age or body composition, but if you are an older lady and/or overweight it is possible that your hip just "wore out".

Hope I have helped Smile

regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

dizzybuff38 · Posted: Fri Apr 01, 2005 3:32 am Post subject: bone mets

Thank you Dr. Leo for your reply. I am 60 yrs old and weigh 120 lbs, not overweight at all. I asked my GP (only peson I seem able to get to see) if he thought it might be arthritis and he said this would have shown on the x-ray. He doesn't see the need for a bone scan, feeling the alk blood test and x-ray were sufficient. The physio thinks it is to do with a nerve in my spine (L4 and L5 vertebrae have collaped due to long term steroid use). When I finally get my annual check up with the breast surgeon I will ask for his opinion and perhaps he can order a bone scan. I wonder if it is a side effect of Arimidex as bone/joint pains seem prevalent.
Many thanks, Liz.

Minnlady13 · Posted: Fri Apr 01, 2005 9:41 pm Post subject: Re: Bone metastases

Hi Liz, I can't really answer your questions, but it looks like Dr. Leo has started a dialogue with you. I just wanted to welcome you to your board. Sorry you have a need to be here, but glad you found us. It is always nice to have access to people who have "been there and done that." I am hoping that your hip pain is just arthritis. Sad isn't it when we hope for arthritis? Take care and don't hesitate to bring your questions and concerns here. Lauri
_________________
Diagnosed 4/11/1996
Lumpectomy, 6 mm tumor
Neg. nodes
ER/PR+
33 rads
Tamoxifen, 5 yrs.
NED

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Dizzibuff,

Because of your compression fractures, you already have established osteoporosis, so a lot of things can happen. Still, even if you got a bone scan it could light up, but it can be hard to differentiate purely degenerative arthritis from a bone metastasis. Even if you are not overweight, you can still have degenerative arthritis, and if your hip is severely damaged you might be a candidate for a hip replacement. Please bring up that issue with your doctor.

best regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

dizzybuff38 · Posted: Mon Apr 11, 2005 3:45 am Post subject: bone mets

Dr. Leo - thank you for your kind response. I am seeing the physio again today for treatment. She said if it is no better after this 5th therapy she will refer me back to my GP for a bone scan - she is unable to authorise it. In the meantime I have received an appt with my breast surgeon for annual check up on 19th April and will bring this to his attention.
There was an article in a national UK newspaper last week detailing magnetic resonance neurography for back/hip pain, which can show nerves - it has been developed by CedarsSinai but I doubt it is available where I live, or even in the UK. As she thinks my problem is either a trapped or inflamed nerve, this would be the course to take. Thank you for your help and insight.
Liz.

dizzybuff38 · Posted: Mon Apr 11, 2005 2:53 pm Post subject: Update...

Saw my lovely young female physio today - showed her the article on magnetic resonance neurography and she had never heard of it - not surprising in this backwater of South West England. She did some more therapy today and can move my left leg a lot more without pain - now she tells me it is muscular, something to do with the piriformis muscle and a nerve being trapped there. I think she is grapsing at straws because she really wants my GP to send me for a bone scan, which he has so far ruled out. Guess I won't settle until I get a bone scan and can rule out bone mets. Thank you for being there for all of us - we should all have such a caring and compassionate doctor as you.
liz.

Muttsmom · Posted: Mon Apr 11, 2005 4:52 pm Post subject: Re: Bone metastases

Hi Liz,
Like you, I'd want a bone scan to be sure it wasn't bone mets but I can tell you from experience, Arimidex can cause some major pain. I had a bone scan because of hip pain that was new (had stiffness and pain in my finger joints/feet and ankles, which started shortly after the Arimidex). I just knew it was bone mets, but that's the 1st thing we think about. My bone scan was fine, showed some degenertive (sp) places and 3 healing fractured ribs (not a clue how I did that). I also had a bone density test which showed the very earliest stages of osteoporosis (sp) so my onco went ahead and put me on Actonel. Within 2 weeks (you take it once a week) I had no hip pain, no feet/ankle and finger pain and have felt SO much better, almost human..... lol I had lower back pain and by physical exam, my onco said it was a disk, but he saw how stressed I was, so he went ahead and sent me for a MRI and, it was a herniated disk, no mets. We are going to feel pain, that had we had it before BC, we wouldn't have thought anything about it, but now, everything scares us unfortunately.
Just wanted to give you my experience with bone/joint pain and what I found out. I celebrated having a herniated disk and only we can celebrate something like that ...... lol
Hopefully someone will get that bone scan scheduled and find out what's going on and you might want to ask about Actonel or Fosamax to help strengten the bones, because Arimidex will do a number on them. Praying for good results and relief from the pain.
Hugs
Nancy
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

dizzybuff38 · Posted: Fri Apr 22, 2005 3:56 am Post subject: Bone mets?

Nancy, thank you for posting - so good to know others care. I saw 3 different doctors on Tuesday at the Breast Care Centre - surgeon has ordered a bone scan, but thinks the pain is due to sciatica. Has told me to continue with weekly physio until we get the bone scan and the results.
Ropey lump in breast has turned out to be thrombophlebitis in a vein - never heard of it before. The Director of the Clinic did the final ultrasound and came up with that dx - she said it is rare, but nothing to worry about. She must have seen thousands of breasts so feel I can trust her judgement.
Hugs, Liz.

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