Panicking/Wimping out
 

Hi, I have been NED for three years and had forgotten to worry about cancer for a while. However, I have just cracked a rib/done muscular-skeletal damage while pruning (using my ribcage for leverage cutting through thick rose canes and something "gave.") Breathing hurts, and the pain makes my pulse into brief palpitations/panic. Nausea from codeine makes me panic too (trauma takes me straight back into discomforts of chemotherapy treatment period)
Question: could my ribs have cracked too easily because of bone mets?
My GP refused me a CA15-3, but offered a bone scan in a couple of weeks if I am still having pain/problems. At the time, I was in pain, feeling wretched and scared and not very assertive so meekly accepted her marker refusal. Decided a bone scan will help eradicate my worry if it shows anything of help, but I am now aware that any healing fracture will light up as well as any malignant spots.
She also said I should be dosing up with Panadeine Forte, ie Tylenol 2 because these fractures do hurt all the time. Codeine makes me nauseous and breathless so I am sticking to 4x2x500 tylenol/paracetamol. If I try to take less, I start panicking because of the pain. And I cannot do much physically because anything that uses my arm/arms or chest or back tends to hurt.

I know I have been very lucky having a couple of pretty good years post treatment, and that the tests may well show I am continuing to be lucky.

And I know I currently have nothing saying I am in the shit.

But right now I find myself panicked into eating because of the nausea from either pain or codeine, and panicked about the possibility of bone mets, and panicked at being able to do so little without pain.
I soo sooo soooo do not want to be back on the treatment treadmill with more cancer in my body. I know this is a place many of you have been many times.
Any suggestions?

Re: Panicking/Wimping out
 

Jessica,
First just try to breathe - I can understand your anxiety, but time spent beating up on yourself isn't helpful. It's great you are going to have a bone scan as it will force your doctors to pay attention to whatever does show up. I can't understand why your doctor wouldn't give you the simple blood test, though of course on its own it may not tell you much. Try not to panic. Easier said than done, but we are here for you.
Best wishes..... Pam

Re: Panicking/Wimping out
 

Jessica some years ago I had myself in a similar panic, a hot spot showed on my bone scan so this was followed by an MRI. This was inconclusive so it was decided to biopsy the spot in question, turned out it was too small so this was followed by a PET/CT which finally showed no cancer phew..

I can well understand your panic and fears which are very real, however the sooner you get some scans done the sooner you'll have the answers you need. No matter how much you worry it won't change the outcome, could your Onc go straight to an MRI and skip the bone scan perhaps? it's bound to light up if those ribs are broken, they could be just bruised though. I know it's hard but try to breathe and stay calm and hassle the Onc to investigate more asap. Sending good wishes for clear results.

Re: Panicking/Wimping out
 

Jessica

As far as the pain goes, Tramadol probably would work better than Acetaminophen.
It is unrelated to Codeine and shouldnt have similar side effects. Actually it is chemically related to the antidepressant Effexor. Speak with your doctor as it may help

Paul

Re: Panicking/Wimping out
 

Jessica I am so sorry this is happening ... is there any way you could contact your oncologist and tell him/her what happened to get the bone scan moved up and perhaps the blood test given? I am figuring when you say GP you mean your General practice family doc and not the oncologist.

Carol Ann

Re: Panicking/Wimping out
 

Jessica,

I was looking in your signature for your age, but could not find it. A fractured rib from pruning does seem odd for a younger gal, but not if you are 60+ish. That said, we can injure ourselves in the silliest of ways, so I still would not be all that panicked. HOWEVER, panic sucks and seeking to alleviate the panic is perfectly fine. Your Onc. has never known the crushing panic of cancer fear, so (add your best Bronx Cheer here!).

Estrogen positive BC tends to like to mets to bones, not so much hormone neg Her2+ variety that you have, so take that for a bit of good news. My suggestion is to give it another 2 weeks to let it heal a bit. I am not a fan of Tylenol. It is terribly hard on the liver. I know Nsaids such as Ibuprofen and Aleve have their issues as well, but I personally prefer them over Tylenol. I also like Tart Cherry Extract and Glucosamin/Condroitin for bone pain. Those two are great for joint pain and arthritis as well.

I think I would ask for the bone scan as soon as things are healed comfortably just to be sure there is no mets. You are certainly not a hypochondriac to worry about a cancer component. You are a cancer survivor, afterall! Those of us in the Cancer Club always have a fear of its return, so do not be hard on yourself. You are normal in our world!

Re: Panicking/Wimping out
 

I am sure the anxiety must be crippling. Let us know how the bone scan goes. My experience tells me it will be "hot" because healing fractures usually are so don't panic if it is, especially if it's the only hot spot.

Re: Panicking/Wimping out
 

Hi, thanks for all the support and understanding. I contacted my oncologist and she thought the bone scan was a good idea. I had it today, about 5 weeks after the injury. It showed not one but three hotspots on my ribs, two top middle, just under where my breast cancer/DCIS were, and one at the junction of sternum and bottom joined-on rib, which the tech said were broken ribs. A number of other bright spots including my right elbow that I must have broken in 2014 when I landed on it after falling very painfully on concrete.
He asked me if I had been diagnosed with osteoarthritis, which I haven't (though I may have it).
He also told me he couldn't give me my scans and report, that they could only be sent to doctors. (I later checked and found this is totally incorrect, I am entitled to them if I want them, and the admin lady said she will have them ready for me to collect when I am in town next) But these questions left me wondering if there was something bad he thought I should be hearing from my family doctor not reading by myself.
Hmmmm. Almost there....maybe, though I see from your stories that my bone scan may not give the full or even any answers, but here's hoping :-)

Re: Panicking/Wimping out
 

BTW, I am 65, so old enough to break bones more easily than when younger.

Re: Panicking/Wimping out
 

Jessica,

What did you find out? Is all okay? And as others have said, as a cancer survivor we all understand that panic that comes with any pain or discomfort. It's scary and unfortunately a normal reaction for us.

Re: Panicking/Wimping out
 

Hi Lucy, I had my bone scan but the technician told me I could not see or get a copy of the report and films directly, only via my GP.
I rang admin and complained that this was my information, and they agreed I was entitled to a copy and said they'd ring the hospital radiology clinic and organise it for me. I got there and no report. The receptionist printed it out but said no films, only laserprint copies of the images.
So finally I got the report and discovered that there was no mention of breast cancer bone metastases being there or not being there. I rang radiology company's admin again, and they said that oncologists getting this test done for this reason ask for a whole body scan (which was actually done when I insisted) and they ask for a full body report (which my GP failed to do) and they specifically ask for a report on presence or absence of bone mets from breast cancer left breast 2014. Which she failed to ask for.

I was royally pissed off. I had had this moderatly high dose of radiation and got back a report that I had 3 broken ribs. Woopy doo. I kinda knew that bit. I wanted an in depth checkup that there was nothing ominous happening too. I got a series of calls from my GP's receptionists then asking me to come in for a non-urgent appointment to report on my bone scan. Which I ignored but was annoyed by.

I had an oncologist appointment the following week, so I thought this would solve the problem. I rang the oncologist's receptionist and told her the problem, and she said she'd talk to someone she knew at the radiology company, and would get Arlene to sort it out. However, Arlene clearly had not investigated further, and just patted me on the head (figuratively anyway) and rather patronisingly promised me that the good radiologists would have seen any bone mets even if they weren't told to look for them. So I was even more pissed off.

I then sat down and wrote a letter to my GP diplomatically asking her to help me sort out a problem about my bone scan that I was needing help with. And outlined the above. A week later I got a voice message from the GP herself, telling me she had contacted the radiology company and sorted it out and wanted me to come in for an updated report on my bone scan. She wasextremely kind, told me that the radiology people had assured her that the person who did the report did have all my breast cancer test results from the suspicious mammogram onwards, so would have known my history and would have checked thoroughly. And found nothing untoward except the 3 broken ribs, and severe osteoarthritis in my right elbow. I have not had a check for osteoporosis for a long time if ever, but she wants to leave this a bit so I don't get too much radioactive dye dumped on my system at once.

Now this issue of severe osteoarthritis in my right elbow is of concern/interest to me. I broke it in the middle of having chemo, about 3 months after surgery. So I was wondering what the monthly neulasta, and the doses of Docetaxol, Carboplatin and Herceptin might have done to my injury as it tried to heal. And maybe stem-cell-like tumor cells floating around my system. Any one else got any similar experiences? Is this likely to have been misread and actually be a bone met?
thanks Lucy for following through, and holding me in mind
Jessica

Re: Panicking/Wimping out
 

I'm sorry you've had such poor service and reassurances from your medical team. I imagine it must be very frustrating. I'm not sure there is any way to verify metastasis without a biopsy.

Re: Panicking/Wimping out
 

Thanks for your understanding: it is very frustrating.

One way to check for mets other than a biopsy is the ca15.3 marker This is at least useful to check that there is no metastatic cancer: ie if it is at your normal level (usually that's under 30) and stays there, the cancer is very very unlikely to have metastasized. If the ca15.3 level goes up a lot, there are other things that can cause that but if there are other reasons for concern, then it is a reason to check those out very thoroughly. It does not give any indication of new cancers or any regrowth other than mets.

But my onc is very anti me having this on-going. And I think she may have told my GP not to keep doing these, coz the last one I had was when the onc had refused and I got my GP to do it.

I am also really interested now to find out if others who broke bones during chemo/neulasta treatment also develop severe arthritis where there was nothing before. And what can be done to help heal/reverse that change, if anything.