Yes, but it can't get much worse than fractured, and on the other hand rads
would seriously interfere with the healing of the fracture.
Be aware that the effects of radiation on pain are not immediate anyway, it
takes a few weeks before you notice the change, maybe six weeks till it
stops hurting.  This is partly because even if the tumour dies instantly,
the bone is still damaged and has to grow back.

Zometa or similar bisphosphonate to encourage bone regrowth, there is also
evidence that it inhibits bone tumour growth.

NSAIDs like Celebrex to help with pain relief and lower analgesic
dependency.  But there was a study showed that the COX2 inhibitors
(Celebrex, Vioxx) also slow bone regrowth, so there is a bit of a trade-off
there. Older NSAIDS have more severe side effects mainly stomach
inflammation.

An antacid with the NSAID to reduce stomach problems.

Fentanyl 72-hour patches for severe and chronic pain, if it is that bad,
with oral liquid morphine for breakthough pain.

A laxative with the narcotic, and adjust the dose -slowly-, it takes days to
work through.

This was the sort of stack of meds my wife had when she had spinal mets
(except Zometa hadn't been invented in 1999).

Tim Jackson

Tim wrote: << I thought bone marrow biopsies were only for leukaemia and other
blood
conditions.
How do they work for bc bone mets?
Do you have a reference on this?
I vaguely remember you mentioning this before, forgive me if I already asked
you this and forgot.  Tim>>

In addition to the following below, it is now being suggested that prophylactic
use of a bisphosphonate such as Zometa at time of b.c. dx, may prevent  bone
mets.  I am not including that article here--but if  you'd like more info about
it, let me know.
"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list
_uids=98357981&dopt=Abstract
1: Breast Cancer Res Treat. 1998 May;49(1):27-33.     Related Articles, Links

Prognostic value of bone marrow biopsy in operable breast cancer patients at
the time of initial diagnosis: Results of a 20-year median follow-up.

Landys K, Persson S, Kovarik J, Hultborn R, Holmberg E.

Department of Oncology, Sahlgrenska University Hospital, Goteborg, Sweden.

From May 1975 until May 1980,128 operable breast cancer patients, clinical
stage I-II, had a core bone marrow biopsy (BMB) from the posterior iliac crest
as a part of the routine diagnostic work-up at the time of initial diagnosis.
The mean age of the patients was 56 years, range 26-93. In a previous study on
this material, 10 patients (7.8 per cent) were positive for tumor cells and 118
negative by conventional histopathology of BMB [1]. In 1996 we reexamined all
BMB separately at two laboratories, using monoclonal antibodies against
cytokeratins AE1-AE3, KL1, CAM 5-2 (DOP), and DC10, BA17 (MCI). The number of
extrinsic cells in the bone marrow was graded positive for micrometastases when

marrow cells were found, using high power field magnification. Micrometastases
were detected in 17 patients (13.3 per cent) and another 8 patients were
classified as suspicious. The presence of micrometastases was correlated to the
axillary lymph node stage and primary tumor location. Median follow-up was 20
years. All 17 micrometastatic patients relapsed and died within 6 years of
disease progression with evident osseous metastases. There was one disease-free
survivor of the 8 patients with suspicious BMB after 17 years of follow-up. The
median overall survival was significantly shorter in tumor-cell positive
patients, being 1.9 years compared to 11.7 years in the BMB negative and BMB
suspicious groups (p < 0.0001). Immunohistochemical analysis of core BMB taken
postoperatively may be useful in predicting the prognosis in patients with
breast cancer clinical stage I-II.

PMID: 9694608 [PubMed - indexed for MEDLINE]"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_
uids=8931609&dopt=Abstract
1: J Natl Cancer Inst 1996 Nov 20;88(22):1652-8    Related Articles,
Links
Micrometastatic breast cancer cells in bone marrow at primary surgery:
prognostic value in comparison with nodal status.
Diel IJ, Kaufmann M, Costa SD, Holle R, von Minckwitz G, Solomayer EF, Kaul S,
Bastert G.
Department of Obstetrics and Gynecology, University of Heidelberg, Federal
Republic of Germany.
BACKGROUND: Approximately 30% of the patients with primary breast cancer who
have no axillary lymph node involvement (i.e., lymph node negative) at the time
of surgery will relapse within 10 years; 10%-20% of the patients with distant
metastases will be lymph node negative at surgery. Axillary lymph node
dissection, as a surgical procedure, is associated with frequent complications.
A possible alternative to nodal dissection in terms of prognosis may be the
immunocytochemical detection of tumor cells in bone marrow. PURPOSE: In a
prospective study, the value of tumor cell detection (TCD) in bone marrow was
compared with axillary lymph node dissection in the prognosis of primary breast
cancer after surgery. METHODS: Data from 727 patients with primary, operable
breast cancer were included in the analysis. All patients had surgery,
including axillary lymph node dissection, from May 1985 through July 1994 at
the Women's Hospital of the University of Heidelberg (Federal Republic of
Germany). Bone marrow aspiration at two sites on each anterior iliac crest was
performed immediately after surgery while the patients were under general
anesthesia. Most patients received some type of systemic adjuvant therapy. The
monoclonal antibody 2E11, directed against the polymorphic epithelial mucin
TAG12, was used to detect tumor cells in bone marrow samples. The association
of TCD with recognized prognostic indicators was evaluated by means of
chi-squared tests. Survival without the development of distant metastases
(i.e., distant disease-free survival) and overall survival were estimated by
use of the Kaplan-Meier method; the logrank test was used to compare survival
curves. A multivariate Cox regression analysis with stratification according to
adjuvant treatment type was used to assess the independent prognostic value of
TCD in bone marrow in relation to other variables. Reported P values are
two-sided. RESULTS: Tumor cells were detected in the bone marrow of 203 (55%)
of 367 lymph node-positive patients and in 112 (31%) of 360 lymph node-negative
patients. TCD was associated with larger tumors (P < .001), lymph node
involvement (P = .001), and higher tumor grade (i.e., more undifferentiated) (P
= .002). After a median follow-up of 36 months, patients with tumor cells in
their bone marrow experienced reduced distant disease-free survival and overall
survival (both P values < .001). TCD was an independent prognostic indicator
for both distant disease-free survival and overall survival that was superior
to axillary lymph node status, tumor stage, and tumor grade. Among patients
with tumors less than 2 cm in diameter, TCD was the most powerful predictor of
outcome. CONCLUSIONS AND IMPLICATIONS: TCD in the bone marrow of patients with
breast cancer is a valuable prognostic tool associated with negligible
morbidity. Prospective randomized studies should be performed to determine
whether TCD might replace axillary lymph node dissection in a defined subgroup
of patients with small tumors.
PMID: 8931609 [PubMed - indexed for MEDLINE]"
"http://www.abstracts-on-line.com/abstracts/BCS/search/Results.asp?Num=0%2
E4660456
[213] Clinical implication of detection of isolated tumor cells in bone marrow
in early breast cancer. Results from the Oslo study.
Wiedswang G, Borgen EF, Kaaresen R, Kvalheim G, Nesland JM, Qvist H,
Schlichting E, Sauer T, Janbu J, Harbitz T, Naume B. Ullevaal University
Hospital, Oslo, Norway; Baerum Hospital, Gjettum, Norway; Aker University
Hospital, Oslo, Norway
Date/Time: Wednesday, December 11, 2002 5:30 PM  Location: 
Session Info. : Poster Session II: Detection/Diagnosis: Marrow and Blood
Micrometastases (5:30 PM-7:30 PM)

Background: Detection of tumor cells (TC) in bone marrow (BM) in breast cancer
(BrCa) can potentially be used for prognostication, therapy monitoring and
characterisation for individualised treatment. The presence of tumor cells (TC)
has been shown to affect clinical outcome. However, the clinical significance
of TC detection in node negative (N0) differs in previous studies. The aim of
this study is to clarify the clinical impact of detection of TC in BM in both
node positive(N1) and N0.
Material and Methods: BM aspirates were collected during operation from 920
patients (pts) with early BrCa. Mononuclear cells were isolated, cytospins
prepared, followed by immunocytochemical analysis (using the anticytokeratine
antibodies AE1 and AE3) and detection of TC. Immunohistochemical analysis of
erbB2, p53, catepsinD, ER and PgR-expression were also performed. All pts
received therapy according to the National Guidelines. The pts were reexamined
every 6-12 months.
Results: 532 pts with N0 (63%) and 288 pts with N1 status (34%) were enrolled
and evaluable (total 848 infiltrating carcinoma). TC were detected in BM in
12.6% (N0 9.4%, N1 19.5%). Median FU is 49 months. So far 189 pts have
experienced a relapse, 87 locoregional and 133 systemic. BrCa death has ocurred
in 100. No difference in the frequency of locoregional relapse was observed in
BM+ vs BM- pts, whereas 28.8% of BM+ (N0 8.0%, N1 24.0%) and 13.1% of BM- (N0
7.8%, N1 49.1%) experienced systemic relapse. BrCa deaths were detected in
43.9% of the BM+ and 18.9% of the BM- N1 pts (p=0.003, logrank test). No
difference in survival was observed in N0 pts.
Conclusion: Detection of TC in BM predicts future systemic relapse and BrCa
death in N1 BrCa. However, based on this study, BM status cannot be used as a
prognostic factor for N0.The primary tumor analyses will be compared to the BM
results and clinical outcome - and presented."

Its simple: The fracture has to be operated on anyway so the orthop.
surgeon just takes bits of tissue from the fracture surfaces for
histology during the operation.

Kaye wrote:

Tim is right. Your blood cells; red, white, platelets, are
"manufactured" in your bone marrow. A biopsy is done to obtain the
growth factors of your blood. Your marrow is in the large bones of the
body. That is why a biopsy is done by either pushing a needle thru your
hip bone, pelvic bone, or sternum to obtain the bone marrow. A pathology
report will examine not only the counts, but also at what rate your
cells are 'turning over'. This is done to confirm a diagnosis of blood
cancers or disorders.

In my case, all my blood tests within a 2-week period showed all the
cell counts too high. The hema/onc. would not commit to a final
diagnosis and start treatment until he did a bone marrow biopsy which
would confirm a greater proliferation of blood cells being
'manufactured' in the marrow. This meant that my body had a much greater
blood volume and a high viscouity. My blood was like oil rather than
water, putting me at great risk for a stroke. The treatment is
phlebotomies. Four pints were removed over 5 weeks and the onc. goes the
hematocrit count in the CBC. In my case, he wants to keep it under 40.
Before treatment it was 63.7.

So, a bone marrow biopsy would not be a way to detect breast cancer
mets. It would be a way to detect leukemia or some other blood disorder.
The word "bone" is the place that contains the marrow which makes your
blood.

Kathie

I forgot to mention...
Saima wrote << "Many people don't know but sickness is a blessing according to
Islam for
the faithful servant, for a patient and well-behaved Muslim who doesn't
flare up or rebel, and for those adept and graceful servants who know that
sickness comes from God, and who don't oppose the destiny or complain...>>

Um, that's not what I have been doing.  I am protesting--loud and clearly.  I
AM challenging current standard protocols.  I did the same for one of my
children re. a medical condition--and it worked.  My protests are based on
valid research findings that are not in sync with latest protocol in practice.
 I am not one to NOT to not protest or complain when I see the need. I do NOT
accept a pre-ordained 'destiny.'  Now, cancer may be an inevitable fact in my
case due to genetics, but I DO believe that the information is out there to
better individually control its course if treatment is strong enough and  long
enough and directed at the correct, involved pathways.  I may have been
well-behaved, at least for the most part, but certainly have not been patient.
I do not see my demise as a reward for the life I have lived--and refuse to do
so.  I do not await an afterlife or have any pre-expectations of future rewards
and enjoyment.  I believe in making a difference--NOW--and HERE--while I am
alive on this earth.  Frankly, I do not have much interest in anything personal
afterwards, but I do want to be here for my children and any future
grandchildren.  I do not want to put my youngest daughter through yet another
death, if at all possible.
And, as Madiba wrote:
aa <azakram2@comcast.com> wrote:

This is cynical, cruel.

This interpretation seems a denial of reality and if there is a G-d who is
there and a witness to life events--the utmost form of disrespect.  In fact, to
me it suggests a G-d that does not have the power to intervene.  It is not what
G-d is all about.
Sickness is a natural part of life, but so is living and wellness too.  If
there is an intervening G-d, that power has given us the ability to better
understand, intervene and change the course of illness.  There is much more
knowlege that is there that has not yet or is not  being consistently
implemented into practice.  And, that, too, is also cruel...
I guess I am not a 'patient' person (no pun intended).  I am a south-paw (left
handed) and more of a global reasoner than ste-by-step thinker.  Left-handed
individuals often use more of their right, more spatially-oriented brain in
processing information.  Oftentimes, they're strength lies in being able to
better conceptualize a pattern or the 'whole picture' rather than analyze the
individual parts.  Then again, I am probably over-doing the latter,
too...sigh...is there no rest for the 'wicked' ;-)

I suppose it depends how you look at it.
I read it as meaning the sick person is excused the duty of worship.

Tim