Ann wrote << I had cortisone for hip pain, and they told me to wait 1-2 weeks
to feel the
improvement. Indeed after about 8 days it is now feeling less painful!  >>

Thanks for sharing--that is so good to know.  I once had a cortisone shot for
'tennis elbow' and the improvement was immediate.

Your toe and ankle pains aren't mets.  Bone mets mainly occur in the big
bones, head and torso, typically spine, skull, ribs or hips.  They are rare
in the extremities, OK Catharine has them but Catharine is very special, and
more to the point already had mets in just about every other bone of her
body.  More likely you already had arthritis developing in those areas and
the cancer treatments have exacerbated it.

It is true that the bone scan lights up both for osteo-arthritis and for
cancer, but the radiologist will also look at the pattern of uptake, and
will mentally subtract typical arthritic patterns from the image.  The
implication is that your radiologist thinks your pattern of hotspots is
fairly normal for someone of your age and not indicative of cancer.  Like
everything else in medicine, it is a matter of judgement and not a hard and
fast rule.

Tim Jackson

Catherine wrote << everytime something is different in
my body, I wonder and I wonder if I should ignore it and I wonder if I
should complain until somebody validates that it isn't serious.  Anyway, I
know what you are going thru!

Catherine, so good to hear from you.  I hope your daughter is doing well.
Re. the above, it is so hard to know.  My oncologists response re. not
answering my question re how one differentiates bone mets from arthritic
activity and saying that it didn't matter in terms of overall survival if one
treated bone mets sooner, really threw me for a loop.
My understanding is that stats report that about 2/3 of all women with breast
cancer eventually get bone mets.  I don't know what % get arthritis unless
everyone has some arthritic activity.
In my case, about 10 years ago, after a car accident I was told that I had
arthritic activity in my knees as well as other areas.  However, none of the
scans I've had since b.c. dx, report any arthritic activity in that area which
was clearly pointed out to me back then.  Do arthritic changes go away?  I
don't get it.
Yet, the scans do report increased uptake in areas that are common for
metastases to occur.  Other 'unusual' changes were also reported there.  They
do tell me that bone metastases can't be ruled out.
The philosophy seems to be that 'they' are looking at alternatives before
declaring these changes to be cancer-related.  That seems a bit incongruous in
terms of reality, however.  While nobody wants to hear of metastatic disease or
further advanced cancer, the reality is that the stats report that early
treatment of metastases doesn't make a difference in terms of long term
survival.  I think those stats are totally invalid because the significant
variables are not being controlled for and there is no consistency in the
criteria used to test or diagnose mets.  Mets usually aren't diagnosed until
they are quite proliferative.
I used to wonder why tumor markers weren't used to test for cancer.  They would
have shown that I had cancer going on.   The markers were above normal at time
of dx, and they returned to normal after treatment.  I recently learned that
they are rarely elevated in early stage cancers (which further reinforces my
feelings that with all that I had going on that my cancer was much more
advanced).
One reason for not wanting to deal with patients who are at beginning stages of
metastases is that there is no standard treatment protocol, nor is there much
research to back up what may or may not work during this phase.  As I have
written before, in my research I learned that the standard "4 AC" protocol was
adopted  on the basis of compromise and convenience.  At least one of the
researchers did not approve.
There isn't alot of research on alternative forms of treatment or even
prolonged treatment.  However, there is still inconsistency.  I recently met a
gal with stage IIIb b.c. dx.  She was having a hard time getting her insurance
to cover the recommended treatment--Taxotere, Carboplatin, and Herceptin since
it was still in clinical trials.  She then switched to a PPO and was told that
she will get Herceptin for the rest of her life.  I happened to see one of the
developers of Herceptin to see if I could get it extended.  He was very short
with us--and just said "one year" and wouldn't even discuss.  This gal that I
met will be seeing that same oncologist and he is allowing her to continue
Herceptin beyond a year.
Thus, even going for a second opinion may not give you the same results with
the same dr.'s.  They are basing their suggestions on the coverage allowed in
your existing insurance policy.  It has taken me alot of frustration and
searching to realize that.
If one goes to some of the support boards, there are several posting who were
at early stages at time of dx who developed recurrences after standard
treatments.  Now there might be ascertainment bias there--those who recur are
the ones posting; those who don't have recurrences aren't involved in support
groups.  However, something still seems very wrong.
Progress is being made in terms of treatment of b.c. in terms of lengthening
overall survival or prolonging  remission.  At the same time dr's are not
always truthful in their explanations of what cancer is all about.
Now, back to bone pain and arthritic activity.  I encountered someone on line
who has spinal mets whose symptoms and scan findings are quite similar  to
mine.  Interestingly, I did find an oncology nursing text which states that
sciatic pain may be due to bone mets.
In regard to alot of the symptoms I have, none of my peers are experiencing
anything of the sort.  Those who do have some arthritic activity, have very
different symptoms.  In addition, I am on high dosage of an NSAID (celebrex)
which should help with that.  It does help with the stiffness in my knees.  I
do suppose that the Arimidex could accelerate other degenerative changes.  Yet,
those with bone mets report very similar discomfort as I have described.
I am not certain of the criteria for dx'ing bone mets but do suppose that it
follows a certain pattern.  From what I gather different dr's and cancer care
centers use differing criteria.  Some appear not to dx until it is extensive.
Susan Love writes in her book, Dr. Susan Love's Breast Book, 2000, Perseus
Publishing, p. 562,  "Metastasis to the bone is usually diagnosed when the
patient experiences pain.  Sometimes it's hard to know if te pain is ordinary
back pain or some diesease, like arthritis.  Usually the pain you get with
breast cancer in the bones is fairly constant and generally doesn't improve
over time.  With arthritis, you wake up in the morning and feel stiff, but get
better as you move around during the day.  With some muscular problems that
cause bone pain, the more you do the worse the pain gets. But the pain from
cancer is steady, and usually remains even at night, when you're not doing
anything.  The pain is caused by the cancer taking up room in the bone and
pressing on it, and so sometimes it can get worse in different positions: if
you're standing up on the bone you might be compressing it more and causing
more pain than if you're lying down.  If you have pain that lasts more than a
week or two and doesn't seem to be going away, and isn't like whatever pains
have been familiar to you in your life, you should get it checked out."  

Catherine wrote << I have shoulder pain in my right side and can't lift my arm
high anymore.

I have that in the shoulder in the non-lymphedema arm.  I have read that
several with b.c. have similar discomfort.  Some have dx' of shoulder mets.
Others don't.  Interestingly, the only people I have come across (other than my
sister who has a definate physical injury to her shoulder) with shoulder pain
such as described above are women with breast cancer.   That doesn't mean
others don't have it--but of family and peers, the only ones I know have b.c.
dx.
What concerned me re. possibility of shoulder mets was Tim's story of how bone
mets were discovered with his wife.  She first felt pain after an injury or
over use that didn't go away.  I first felt pain about a year ago which was
intermittent in my shoulder over the past year.  Since August, after light
gardening  it has been on-going.  X-rays reported only 'degenerative changes'
(no injury).
Of course I very much hope and pray that what is going on with me is NOT mets.
However, it is hard to disregard the stats...It is quite interesting to note
how stats are used re. b.c. and treatment(s).  Thought you might find the
following of possible interest...

http://www.nethealthbook.com/rheumatologicaldisease_shoulderpain.html
"Tumors in the shoulder: One of the causes of shoulder pain can be a tumor,
either benign or malignant, that is growing in the shoulder blade or the upper
end of the humerus. Benign cysts are not uncommon. Unfortunately, malignant
tumors can also be found and are not uncommon either. Osteosarcoma is one of
the common malignant tumors, but kidney cancer and breast cancer are common
cancers that tend to metastasize into the humerus bone and the shoulder blade.
About 18% of breast cancer patients develop humerus metastases (Ref. 5). More
details can be found under the above links regarding these malignancies.
Usually there is pain in a shoulder with metastasis or a primary bone tumor in
the humerus or scapula. X-rays, CT, MRI scans, or bone scans might suggest a
tumor. However, only tissue diagnosis such as a bone biopsy under CT guidance
with pathological analysis will confirm this diagnosis. An orthopedic surgeon
and likely an oncologist need to be consulted to help with all of this and the
appropriate treatments.
Disclaimer:
 This outline is only a teaching aid to patients and should stimulate you to
ask the right questions when seeing your doctor. However, the responsibility of
treatment stays in the hands of your doctor and you"
http://www.stat.washington.edu/TALARIA/LS2.3.1.html
"2.3.1 Bone Metastases"
"Multiple myeloma and cancers of the breast, prostate, and lung account for a
large majority of bone metastasis. The most common sites of bone metastasis
include the vertebrae, pelvis, femur, and skull. Distal extremity metastasis
are uncommon (Malawer and Delaney, 1989). The most frequent symptom is pain,
although 25 percent of patients with bone metastasis have no symptoms (Wagner,
1984). Pain may result from direct tumor involvement of bone with activation of
local nociceptors, or compression of adjacent nerves, vascular structures, and
soft tissue. Because patients often have multiple-sites of bone metastasis,
multiple areas of pain are-common. Pain is usually described as dull and
aching, is usually localized to the area of metastasis, and is increased by
movement. However, spine metastasis may impinge upon nerve roots and result in
radicular pain. Patients with metastasis to the base of the skull may complain
of headache; pain on head movement; and face, neck, or shoulder pain Greenberg,
D.html#, Vikram, et al., 1981). Besides pain and immobility, complications of
bone metastasis include fractures, hypercalcemia, and spinal cord compression.
Pathologic fractures occur most commonly in cancers of the breast, lung,
kidney, and thyroid and in multiple myeloma, usually in the proximal femur or
humerus (Oda and Schurman, 1983). Hypercalcemia is most often observed in
cancers of the breast, lung, and kidney and in multiple myeloma.
The diagnosis of bone metastasis is established by radiographic confirmation
and, rarely, biopsy. Radionuclide scintigraphy and magnetic resonance imaging
are the most sensitive means of detecting bone metastasis, often demonstrating
abnormalities before those seen on plain radiographs. Plain radiographs showing
typical lyric, plastic, or mixed lesions are usually diagnostic and easily
distinguished from lesions resulting from nonmetastatic causes (Wilner, 1982).
However, plain radiographs and bone scintigraphy may be negative early in the
course of myeloma and some osseous metastasis and at sites of previously
radiated bone (Kelly and Payne, 1991). Magnetic resonance imaging may be
helpful in such cases when bone involvement is suspected."
http://www.tri-x.com/Info/Histories.html
"Breast Cancer - 1
A. History
*    A 40-year-old female with breast cancer had a lumpectomy along with
chemo/radiation therapy one year ago. The patient began to experience pain in
the right shoulder two months ago.
B. Original Diagnosis
*    A bone scan was negative. A CT Scan was initially read as negative.
C. PET Diagnosis
*    A Whole Body PET Scan found numerous lymph node metastases in the upper
chest.
D. Change in Treatment
*    The treatment plan based on conventional diagnostic techniques would
have been watchful waiting. Thee PET Scan found a number of lymph node
metastases, and the patient was put back on chemo/radiation therapy. A re-read
of the CT after PET still could not accurately gauge extend of disease."