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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2006

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Hot flushes

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Warren - 27 Jul 2006 16:13 GMT
I am on Lupron Depot, 3 month intervals and
Nilutamide daily.

Does anyone know of a drug to reduce these hot
flushes?

Thanks in advance.

Warren,
peace
Bill - 27 Jul 2006 16:38 GMT
If you have hot flushes you need a plumber. :-) For hot flashes the
doctor who prescribed the Lupron will have something for you. Provera
is one.

Bill Denton
RP 2/12/02
PSA .93
Memphis
Joe Price - 28 Jul 2006 00:25 GMT
Actually (this from a menopause web site) -

"Hot 'flashes' is clearly the term that most (US) people are comfortable
with, although 'flushes' is more technically correct," said Elaine Revis, a
scientist at the Center for Women's Health. "It is what actually happens.
Women get a vasomotor flush, a dilation of blood vessels. The result is a
hot sensation and a red flush in skin color. We know that estrogen levels
get very unstable as women approach menopause. As they go up and down, hot
flushes and other symptoms occur. The supplementation of soy-based
phytoestrogens is intended to help stabilize those hormonal levels."

So skip the plumber.

JP

> If you have hot flushes you need a plumber. :-) For hot flashes the
> doctor who prescribed the Lupron will have something for you. Provera
[quoted text clipped - 4 lines]
> PSA .93
> Memphis
Beverley - 28 Jul 2006 03:55 GMT
It's just the inner child playing with matches.

BTW, I promise you will never have one when you are freezing your butt off
trying to shovel snow. They tend to happen when it is 100 F degrees and you
are already way too hot, feeling slightly claustrophobic, and sure you will
pass out any second - that's when they hit!

And they almost always hit when you are ever so tired and you snuggle down
into bed for the night. About 10 minutes later you are soaked, the sheets
are soaked, the pillow is soaked, and your spouse is soaked.  So much fun!
Bev

> Actually (this from a menopause web site) -
>
[quoted text clipped - 19 lines]
> > PSA .93
> > Memphis
Leonard Evens - 28 Jul 2006 13:29 GMT
> If you have hot flushes you need a plumber. :-)

I just checked my online dictionary.  Although, the usual term is 'hot
flash', it would not be inaccurate to use 'flush' instead.   A sudden
rush of blood is called a flush as in

"Sudden a thought came like a full-blown rose,
            Flushing his brow.                    --Keats."

taken from the dictionary.

For hot flashes the
> doctor who prescribed the Lupron will have something for you. Provera
> is one.
[quoted text clipped - 3 lines]
> PSA .93
> Memphis
Heather - 27 Jul 2006 16:39 GMT
Megace worked for my husband.  But it does cause water retention.  Steve
Jordan will be along to tell you about the ones he has tried and his
present one.

Heather
>I am on Lupron Depot, 3 month intervals and Nilutamide daily.
>
[quoted text clipped - 4 lines]
> Warren,
> peace
Steve Jordan - 27 Jul 2006 17:56 GMT
On July 27, the perceptive Heather predicted in response to Warren:
> Megace worked for my husband.  But it does cause water retention.  Steve
> Jordan will be along to tell you about the ones he has tried and his
> present one.
>  
There is no good reason why a pt should have hot flushes, which are a
very frequent SE of  LHRH agonists such as Lupron. Here's an edited copy
of my previous post on the subject:

"There are txs for hot flushes, and they seem not to be well-known among
some inattentive medics. I'll not speculate on the reason. You may
admire my restraint.

They are:

1. Megace (megestrol acetate): some concern has been expressed by one
medic (Myers) that it might encourage PCa development where the tumor
has mutated. Unfortunately, there appears to be no way to be certain
whether this has occurred. Nonetheless, I do know that it is used
successfully to relieve hot flushes.

2. Paxil (paroxetine hydrochloride), an antidepressant. A side effect is
to relieve hot flushes.

3. Effexor (venlafaxine hydrochloride), an antidepressant. Same story. A
friend is finding it to be successful.

4. Depo Provera (medroxyprogesterone, a synthetic form of the female
hormone progesterone), the "label" use of which is as a female
contraceptive. In the 400 mg (contraceptive) dosage, a study (Marx et
al.) has demonstrated excellent results in relief of hot flushes among
men on ADT.

I selected this tx to relieve my hot flushes (6 per night + days) from
Trelstar (triptorelin pamoate).

In my case, I chose Depo Sub-Q Provera 104 mg, the "label" use of which
is palliative tx of endometriosis. In August 2005, I received 104 mg in
each anterior thigh. I have not experienced even one hot flush since
then. I stopped the Trelstar as of the March monthly injection.

However: one must be aware that progesterone is metabolized into
testosterone (T), and should take care that one's PSA is sufficiently
low that a rise in T will not be harmful. In my case, my PSA rose from
0.01 ng/ml to 0.02, then subsided to 0.01, which I feel is more than
satisfactory.

Caveat: what works for me may not work for anyone else in the universe!

In the USA, such use of these drugs is "off-label" which is to say not
approved by the US Federal Drug Administration. The practical effect of
this is that the use of the drugs for relief of hot flushes will not be
paid for by insurance carriers.

I
(1) am not sure of the dosages except for Depo Sub-Q Provera, and
(2) do not know the out-of-pocket costs of the off-label use, again with
the exception of Depo Sub-Q Provera (US$200 for two pre-loaded syringes
+ $25 for the injection at my medic's office).

I consider the cost to have been well worth the result.

Had a bit of fun with my medic and his staff after the injections.
Sighed and observed that from now on I would be unable to ovulate....."

I have heard that use of estrogen might also be effective, but have no
details.

Dr.Strum calls them hot *flushes* which is good enough for me.

Regards,

Steve J

"The author of the Iliad is either Homer or, if not Homer, somebody else
of the same name."
-- Aldous Huxley
ralphv - 27 Jul 2006 18:17 GMT
Warren,
You can start with the least problematic remedy and proceed to
prescription drugs to help you reduce or eliminate hot flushes while on
hormonal suppression.

1. Soy protein taken mixed with fruit juices can reduce and even
eliminate hot flushes. This can also be done by supplementing with
genistein available in health food stores. Red Clover is a good source
of genistein

2. Lachesis is a homeopathic remedy that has been used by women to
reduce the incidence of hot flushes. It works for some men.

3. Several prescription drugs have been used to reduce hot flushes.
Among them:
a. Clonidine, a bp medication seems to work for hot flushes by
inhibition of catecholamines. If used monitor blood pressure.
b. Effexor(venlafaxine HCl) is an antidepressant. It works but it can
have some SEs not related to hormone suppression).
c. Progestin medications such as Megace or Depo Provera. These are
better used when as a result of suppression, PSA is undetectable. Depo
Provera is very effective. Usually one shot can eliminate hot flushes
for a long period.
d. Estradiol patch. A small dose E2 patch is an effective way to reduce
or eliminate hot flushes while on suppression.

Hope one of them works for you.

RalphV
azustoo.org

> I am on Lupron Depot, 3 month intervals and
> Nilutamide daily.
[quoted text clipped - 6 lines]
> Warren,
> peace
I.P. Freely - 27 Jul 2006 18:56 GMT
> I am on Lupron Depot, 3 month intervals and Nilutamide daily.
>
> Does anyone know of a drug to reduce these hot flushes?

I'm sure many will answer your DIRECT question, but only you can answer
your IMPLIED questions:
1.WHAT THE HELL'S WRONG WITH YOUR DOCTOR? This should have been
discussed in great detail in advance, and s/he should be all OVER your
hot flashes by now.
2. S/he HAS radiated your chest to prevent gynaecomastia, hasn't s/he?
3. S/he HAS measured your bone density and started you on
anti-osteoporosis meds, right?
4. S/he HAS instructed you or directed you to a fitness trainer to
initiate a vigorous exercise program to preserve your energy levels, right?
5. You ARE being observed for signs of depression due to T suppression,
right?

And unless most of your answers are "Yesses", I've got to ask what prior
treatment and/or circumstances led to your hormone therapy (ADT).

I.P.
Warren - 27 Jul 2006 19:21 GMT
See below.

>> I am on Lupron Depot, 3 month intervals and
>> Nilutamide daily.
[quoted text clipped - 4 lines]
> I'm sure many will answer your DIRECT question,
> but only you can answer your IMPLIED questions:

First of all, I seem to recall that I informed you
previously that I have complete confidence in my
doctor since being diagnosed and treated in 1991.

> 1.This should have been discussed in great
> detail in advance,

It was.

and s/he should be all OVER your
> hot flashes by now.

I did not tell s/he until now, so it is my fault.

> 2. S/he HAS radiated your chest to prevent
> gynaecomastia, hasn't s/he?

Not necessary in my case.

> 3. S/he HAS measured your bone density and
> started you on anti-osteoporosis meds, right?

Right.

> 4. S/he HAS instructed you or directed you to a
> fitness trainer to initiate a vigorous exercise
> program to preserve your energy levels, right?

Right.

> 5. You ARE being observed for signs of
> depression due to T suppression, right?

Not yet.  I do not feel depressed; quite the
opposite.

> And unless most of your answers are "Yesses",
> I've got to ask what prior treatment and/or
> circumstances led to your hormone therapy (ADT).

> I.P.

Actually I.P. I am very comfortable with the way I
have been medically  treated over the past 15
years and think I'm doing pretty good for being 78
and in good spirits.

Warren,
peace
I.P. Freely - 27 Jul 2006 21:17 GMT
> I informed you previously that I have complete confidence in my doctor
> since being diagnosed and treated in 1991.

I forgot, and Google said you had never posted here before, so all I had
to go on was this thread. (Google sometimes says *I* have never posted
before, so its forum search engine is highly suspect.)

> I.P. wrote
>> 1.This should have been discussed in great detail in advance,
>
> It was.

Your opening question implied otherwise, thus my comments. Sorry.

>> 2. S/he HAS radiated your chest to prevent gynaecomastia, hasn't s/he?
>
> Not necessary in my case.

That's a new one on me, and I don't know how your doc knows that, but
I'll take your word for it.

 >> 5. You ARE being observed for signs of depression due to T
>> suppression, right?
>
> Not yet.  I do not feel depressed; quite the opposite.

I asked the question because millions of people are lousy judges of
their depression, and it's common with ADT (and with natural andropause
in older  men)

I.P.
Alan Meyer - 30 Jul 2006 00:03 GMT
>> ...
>>> 2. S/he HAS radiated your chest to prevent gynaecomastia, hasn't s/he?
[quoted text clipped - 3 lines]
> That's a new one on me, and I don't know how your doc knows that, but I'll take your
> word for it.

I thought gynaecomastia was possible, but not common, with the
luprolide acetate (Lupron, Zoladex, etc.) drugs.  I'd think radiation
would be something you only do if you really have to.

>  >> 5. You ARE being observed for signs of depression due to T
>>> suppression, right?
[quoted text clipped - 3 lines]
> I asked the question because millions of people are lousy judges of their depression,
> and it's common with ADT (and with natural andropause in older  men)

I think it would be very wise of doctors to question their
patients during follow up care about symptoms of depression.
That would be a wise thing for a doctor to do concerning any
patient that has been diagnosed with a life threatening disease,
even apart from HT.   I wonder how many doctors do that.

However, I can testify that in my own case, I got quite depressed
when I found out I had cancer and much less depressed when I
had radiation and Lupron.  I really disliked the Lupron, but it felt
very good to know that I was doing something about the cancer.

I suspect most of us get at least somewhat depressed when we
realize in the full, physical way, that we are mortal and are going
to die, and we see and experience the early stages of it.  But that's
a worthwhile topic for a thread of its own.

   Alan
I.P. Freely - 01 Aug 2006 02:00 GMT
 > I thought gynaecomastia was possible, but not common, with the
> luprolide acetate (Lupron, Zoladex, etc.) drugs.  I'd think radiation
> would be something you only do if you really have to.

Strum says about a third get it to a degree needing treatment. BUT . . .
once ya got it, chest rad is too late. I suspect I'd prefer the rad to
the risk.

I.P.
MAS - 28 Jul 2006 04:48 GMT
Talk to your doctor about switching from Lupron to Eligaard. Eligaard has a
reputative of causing fewer hot flashes. In my case it cut the hot flashes
by 90%.

GD
>I am on Lupron Depot, 3 month intervals and Nilutamide daily.
>
[quoted text clipped - 4 lines]
> Warren,
> peace
MAP - 29 Jul 2006 22:45 GMT
Even though my last HT shot was in February (I had surgery in May), I
still get "flushed/flashed" sometimes.  The Eurotold me that the
effects can stay in the body for 12-18 months sometimes.  I chose not
to ask for any medication, neither was I offered any.  But, I would
rather not take any medication.  Try not to think about this too much
and try getting used to it before you take any medication, it isn't so
bad after a while - in my case, it lasts less than a minutes every time
- like walking by a fireplace :)
Alan Meyer - 30 Jul 2006 00:07 GMT
> Even though my last HT shot was in February (I had surgery in May), I
> still get "flushed/flashed" sometimes.  The Eurotold me that the
[quoted text clipped - 4 lines]
> bad after a while - in my case, it lasts less than a minutes every time
> - like walking by a fireplace :)

This is an excellent way to think about it.  Some people try this
and it doesn't work for them.  But if it does, it's probably a lot
safer than taking yet more drugs.

There was a study about chronic back pain some years ago
that found that counseling could greatly alleviate pain!  Of
course the counseling doesn't fix the person's bad back, but
it could teach him to focus on other things and not let it bother
him.

Counseling was also tested in a study of airsickness by the Royal
Air Force.  They found that many people could be talked out
of being airsick.

We can handle more discomfort than we think and not be
particularly bothered by it if we try.

   Alan
I.P. Freely - 01 Aug 2006 02:01 GMT
> I would rather not take any medication.

What do you call a chemical cocktail that castrates you, triggering a
whole raft of sometimes devastating changes?
And what ELSE can you take to preserve your bones (preventing fractures)?

I.P.
 
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