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Medical Forum / Diseases and Disorders / Cancer / February 2006Message for Mike Radcliffe
Mike, I need to contact you.......... "Steph" <steph@vancouvers.island> wrote in news:d39Af.409310$ki.226293 @pd7tw2no: > <steph@vancouvers.island> I tried emailing you Mike's email addy moments ago. Hasn't bounced, but I expect it might as your email addy seems incomplete. I am leaving at crack of dawn tomorrow, but I'll check for msg from you on figtoes at yahoo dot com (fix obvious) before I go. Be back Sunday. Or you might check with J. Fig > "Steph" <steph@vancouvers.island> wrote in news:d39Af.409310$ki.226293 > @pd7tw2no: [quoted text clipped - 10 lines] > > Fig Yes Fig, my email is bogus. I tried the addy he uses on the NG, but no response > I tried the addy he uses on the NG, but no response He's up to no good, I just know it, I just know it. <wink> Seriously though, for about a year and a half, he's become very slow to respond to emails. Might have to give it a few weeks or more. I'll try something in case he uses "watch thread". J Sorry, I,ve been moving house and been offline for a few weeks. I don,t often have much to add to what evybody already knows these says but dont you know it, when I go off line the call comes through. Actually when I came back online there were about a thousand messages and I deleted most without looking at them on alt.support and deleted all of sci.med without looking (it's usually all ironjustice etc.) As a routine I check e-mail about every other day and ngroups about twice or three times a week. As I,ve said the group has really matured and manages to sort most things out by itself. Anyway, here I am, take me , I,m yours! MIKE >> I tried the addy he uses on the NG, but no response > [quoted text clipped - 7 lines] > I'll try something in case he uses "watch thread". > J Did you get my email, MIke? > As a routine I check e-mail about every other day and ngroups about twice > or three times a week. As I,ve said the group has really matured and manages > to sort most things out by itself. Anyway, here I am, take me , I,m yours! Thanks mike, Situation here. Breast cancer patient, mets to liver and bone. Had episodes of hepatic encephalopathy, due to high levels of ammonia, (which seems to be connected to protein metabolism). I've never heard of this ammonia thing and searched the archives - nothing there of help. She's on lactulose to reduce the levels of ammonia, which causes episodes of diarrhea. "liver pain has been brought under control with taxol, and the bone pain is kept in check by pamidronate". She's got 4 taxol treatments left every 21 days. What I'm wondering is have you ever cared for someone like that? If so, this web page says that lactulose "reduces the blood ammonia levels by 25-50% and this is generally paralleled by an improvement in the patient's mental state and by an improvement in EEG patterns " http://www.medsafe.govt.nz/Profs/Datasheet/a/Alphalactulosesyrup.htm Another web page says that this elevated blood ammonia results in coma and death so: 1) Given that it only seems to partially correct the problem, is that what she's likely to die of? and if so (2), do you recall a timeline (for any of your patients, who had such)? Trying to help husband know what to expect. Also wondering if she was transferred to hospice, would hospice stop the lactulose ? Pain meds constipate which would counter the lactulose getting rid of the ammonia. So is she better off continuing the way they're doing ? Thanks, J If I may add a few details (inline). > Breast cancer patient, mets to liver and bone. Had episodes of hepatic > encephalopathy, due to high levels of ammonia, (which seems to be connected to [quoted text clipped - 15 lines] > 1) Given that it only seems to partially correct the problem, is that what she's > likely to die of? After one month on the Lactulose her condition seems to have stabilized, although at a fairly low functional level. Her mental IQ seems to have dropped about 50 points (from 135 to 85), accompanied by much confusion and forgetfulness. However, the paranoia, psychosis, and physical aggressiveness that she exhibited in the hospital (just before Lactulose treatment was started) is largely gone. > and if so (2), do you recall a timeline (for any of your patients, who had > such)? [quoted text clipped - 4 lines] > Pain meds constipate which would counter the lactulose getting rid of the > ammonia. Before Lactulose and chemo started, she was on morphine sulfate and methadone for pain control. Those were terribly constipating. Now she is able to get by with just four Percocet per day, not enough constipating factor to reduce the rampant diarrhea induced by the Lactulose.  SignatureJohn Richards > Also wondering if she was transferred to hospice, would hospice stop the > lactulose ? Forgot to mention, the hospital doc said that if we ever discontinue the lactulose, my wife would likely be in a deep coma within a matter of days. There's not much point in bothering with a hospice if they'd stop her lactulose meds. SignatureJohn Richards >> Also wondering if she was transferred to hospice, would hospice stop the >> lactulose ? [quoted text clipped - 3 lines] > There's not much point in bothering with a hospice if they'd stop her > lactulose meds. The last time I treated anyone for liver failure was about twenty years ago and the standard regimen was lactulose 30mls three times daily to reduce cerebral oedema (can,'t remember the mechanism but your explanation of rushing contents thru the bowel and maybe drawing water into the bowel sounds valid. An antibiotic to reduce bowel flora and thereby reduce urea/ammonia production and high sugar/low protein intake to prevent the body using protien for energy and thereby producing more toxins. I've never used this in palliative care or seen it used for that matter as there is usually no prospect of the liver getting back any function and transplantation is not an option so really you are prolonging the inevitable. Would they stop the lactulose? probably not....if the engine ain't broke don't try to fix it! If pain is a problem it is more important to fix that than worry about constipation. It's a balancing act. How Long? Can't say Hope this helps some MIKE > Yes Fig, my email is bogus. > I tried the addy he uses on the NG, but no response Strange, I didn't get bounce notice from mailing you... Just checked & he uses same email addy online as I sent. Was good in July. Fig |
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