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Does Radiation Treatment stop the pain?

Bennette
Posts: 65
Joined: Mar 2012

My mom was diagnosed with RCC stage IV at the end of Feb. Then, about 4 weeks ago she had her kidney removed. Just before her kidney surgery her left leg was hurting and it continued to worsen. Last week we took her to her orthopedic surgeon, who had put a pin in her femur in 2008 after a fall. He found that the RCC was in the femur bone, around the middle portion of the post. My mother's spirit went down hill within hours and she was now using a walker to keep weight off that leg. Last Thursday I moved her in with me, as she was not eating and it was too hard for her to take care of herself. Then within 24 hours her back was hurting really bad. We saw her cancer doctor on Monday and he recommonded radiation treatment to be done in conjunction with the first med they are going to put her on, as soon as it arrives. So on Tuesday we saw the radiology dr and he is going to treat the leg and two areas in her spine, previous thought to be compression fractures from osteoporosis; but he believes they too are from the RCC. The treatments start next week. My mom at this point is hurting constently and talking about it not being worth it and it being too hard. She is taking pain meds, so she is also a little loopy. I am doing ok with the comments and just keep getting her to eat and telling her it is going to get better. I need to know if anyone has had radiation treatment to stop the pain from the RCC in the bones - DOES IT STOP THE PAIN???

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

YES!

A good brief recent (Feb. 2012) summary of the topic is here:

http://www.uptodate.com/contents/radiation-therapy-for-the-management-of-painful-bone-metastases

Bennette
Posts: 65
Joined: Mar 2012

THANKS! That was helpful. I guess we just wait and see, hopefully she will be in the percentage that gets enough relief to end the pain meds. I need to be able to talk to her without the drugs, to find out where she is really at on fighting this monster!

Bennette

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garym
Posts: 1651
Joined: Nov 2009

Hi Bennette,

Standard radiation and chemo therapies are not effective against the spread of RCC, I don't know if it will help manage the pain, what does the doctor say? What med are they going to try, votrient, sutent, etc? If it is effective against the RCC the pain should diminish as well, foxhd had mets to organs and bone with severe pain and as the trial he is on shrunk them his pain went away, as reported here he is doing very well today. I wish I could be of more help. Gary

Bennette
Posts: 65
Joined: Mar 2012

Gary,

The radiation treatment is being done mainly for pain relief, in the hopes my mom will be able to get around better. They are also ordering Votrient and she will be starting that soon. Her oncologist said that bone mets don't respond as well to the drug therapy, but there have been indications that they respond better if the bone mets are also treated with radiation just before or while taking the drug. So we are keeping our fingers crossed. My mom is just in so much pain in her leg and back that it is impossible to get her to see there is HOPE! This whole thing just started Feb 28 and we thought she was just starting to accept the situation when they scheduled to have her kidney removed, but during her recovery the past few weeks and with the added discovery of the bone mets last week, she is losing hope faster than we can supply alternatives. I am trying to get down as much fruits and vetables as possible to keep her strenght up and I am just praying the radiation stops the pain! I believe the pain meds are clouding her judgement and affecting her appetite and her emotions - I need to get the pain stopped and get her off the pain meds so I can get her to see that there is still hope. The oncologist also wants to try the IL2 treatment after she has been on the Votrient for 8 weeks. He feels she needs to build up her strength as she has lost about 20 pounds in the past month. I am soooo worried about her mental state, more so than her physical state right now. Bennette

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garym
Posts: 1651
Joined: Nov 2009

Bennette,

Good to learn that the radiation will help with the pain, TW is amazing with research and answers isn't he? Sounds like you are in very good hands with a well thought out plan. Hopefully your mom will find renewed hope with reduced pain and meds. As her main caregiver she will be relying heavily on you so don't forget to take good care of yourself as well.

Good luck and Godspeed,

Gary

Bennette
Posts: 65
Joined: Mar 2012

Gary,

Thanks. I am definitely doing that, trying to eat better myself and get more sleep at night. I still have a 17 year old daughter at home and I take care of my 3 year old grandson from 6:15am - 4:15pm Mon - Fri, as well as manage my husband's dental practice (mainly from home). So my husband is has also made it his responsibility to watch out for ME! He calls me to make sure I remembered to feed myself and listens to me when I need to vent!!! Actually, my grandson has been great since my mom moved in, he plays games with her and carries things around for her and even tells me when she wants something if I am not in the room. Her sister's also came out this week and they are going to come over and stay with her so I don't miss my daughter's soccer and basketball games, since my mom isn't in any shape to go with me right now. I just know she hates having to be cared for, which is why I am hoping that the radiation eases the pain so she can get around without the walker soon. It is strange, as this has progressed and I have been studying up, I am less worried about the cancer itself and more concerned with her mental well-being. It is hard to see your mom weak and helpless and worse to hear her talk about "it not being worth it", etc. But luckily raising 6 children has made me a good pep talker, it is just a bit harder that it is my mom and subject is her life - that is taking its toll - some days worse than others. I don't ever get upset in front of her though, I do that in private so as not to upset her more. My biggest hurddle has been getting use to the idea of idea asking for help, but after missing two of my daughter's games, I realize I am going to have to call and let her sisters and my sisters help out me out so I don't miss out on too much. So, I am still learning myself.
Thanks,
Bennette

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

I agree with Gary that you sound as though you're handling a difficult situation well.

She will certainly need to be in much better shape to handle Il2 treatment. It would be a good idea to take expert nutritional advice. Fruit and veg are always good but she may need an energy-dense (hyper-caloric) diet to help her regain lost bodyweight and strength. What is her BMI now? (If you don't know it, there are calculators e.g. iPhone app "BMI for ADULTS" and on the Web. Otherwise, just tell her height and weight and we can calculate.)

What size was her tumour? Do you know the grade, from the path report? How old is she? Are they putting her on zoledronic acid (e.g. Zometa) for the bone mets?

Your perception about the need for a clear mind is spot on and the criticality of her mental attitude. Is there any possible problem of informed consent re treatment? If necessary, do you have access to an independent advocate (I don't know whether independent advocacy is community-based in the USA - I'm in Europe).

As Gary counsels, do make sure you are looking after yourself well enough too.

Bennette
Posts: 65
Joined: Mar 2012

I haven't taken her to a nutritionist yet. They do have one on staff at KU Med, where she is being treated (in Kansas). I wasn't sure she would be very receptive while in pain and under meds, so I was going to wait until the radiation treatment helps - they are going to do 10 treatments, so it wiill only take 2 weeks to get them all done. Currently, she is about 5'7" and weights 148lbs and she just turned 70 years old in March. I just went with fruits and vegetables because they were the one thing in common in all the cancer diet recommendations I read about. I do still give her a little meat with dinner and usually get her to eat an egg for breakfast, I am just giving her a higher percentage of fruit and vegetables than anything else. To be honest, I don't really know much about diets, but have always been an advocate of fresh versus packaged or canned foods - so I have just been going on my best instints. Any advice in this area is extremely welcome!
Thanks,

Bennette

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

She's a good height for her age and her weight sounds about right for her height as it is now. Your instincts are fine - keep avoiding processed food in favour of fresh as much as possible and get plenty of fluid intake. But do also get expert dietetic advice - handy you can get that at KU.

Bennette
Posts: 65
Joined: Mar 2012

Thanks! I will definitely call them and schedule an appointment with the nutritionist during one of our radiation treatment visits next week. At least then I can get some more information and we can make another appointment later, once we can get her off the pain meds or at least signifcantly reduce the amount of them. My mom is a bit stubborn and it is worse on the pain meds, she is kinda child-like so I have to keep nagging at her to eat her vegetables, as she doesn't like them! She is a little better with the fruit. It is actually kinda funny sometimes, my grandson has grown up helping in our garden and loves fresh vegetables, so he even tells her they are good and she needs to eat them as he hands her a piece of broccoli. It would be good to know how much of what she really needs, so I will get an appointment set up - the more info the better!

Thanks,

Bennette

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foxhd
Posts: 1855
Joined: Oct 2011

Looks like T-W and Gary have covered your questions. I don't know how the radiation helps with the pain, but evidently it does. I have been aware of it being used this way. Good Luck to you and your mom.

Bennette
Posts: 65
Joined: Mar 2012

Foxhd,

If I remember right, you responded when I first came to this place last month after my mom's diagnosis and told me you were in physical therapy. My mom's nurse scheduled her for an appointment with a physical therapist before the radiology doctor saw her and said he wanted to treat it with radiation. The therapist appointment is for Tuesday, I have been trying to decide whether to keep the appointment or cancel it and see how the radiation treatments go first. Do you have any input on that?
Bennette

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foxhd
Posts: 1855
Joined: Oct 2011

Bennette, cancel the therapy visit if it is out patient. They will get overzealous with treatment. If the therapist is coming to the home, do it. A good homecare therapist will work on increasing independence, mobility and confidence in your moms safety at home. It is a different philosophy in care.

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Texas_wedge
Posts: 2807
Joined: Nov 2011

You sure earn your keep here bro! So good for us to have a professional on site.

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rae_rae
Posts: 264
Joined: Oct 2010

Not sure if it will help but you might ask the doc about a (TENS Transcutaneous Electrical Nerve Stimulation) unit. It might help decrease pain a bit without the nasty side effects of drugs. Radiation hopefully will help as well.

I am currently using a TENS unit, though not for cancer, and it does provide some relief to my otherwise constant sciatica.
http://cancerhelp.cancerresearchuk.org/trials/a-trial-to-see-if-a-nerve-stimulating-machine-called-tens-can-control-bone-cancer-pain

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

I'm going to ask a friend who HAD RCC and has sciatica if he's tried/heard of TENS (he probably has). Meantime I'd value your thoughts about it Fox.

Bennette
Posts: 65
Joined: Mar 2012

Thanks fox! I was thinking that might be the case. I will cancel it, but I will also ask about the in home, if she is not doing significantly better after the radiation therapy. We had a bad afternoon and evening yesterday. This stuff must go in waves. She did good the day before and then yesterday, she seemed to be hurting despite the pain meds, it was hard to get anything done her, I had to resort to protein shakes, it was like she was too weak to chew. Then the this morning she seems better again and had an egg and fruit for breakfast without any problem.

I will ask about the tensing, I know my chiropractor has used that on my daughter's knee to help heal from a sports injury.

I just hate seeing her in pain, especially when I can't seem to make it any better. Hopefully today will be a good day!

Thanks all for your input.

Bennette

foxhd's picture
foxhd
Posts: 1855
Joined: Oct 2011

A tens unit is a good tool. They can be set up in several ways for pain relief. It is important to have the correct electrode placement. A great trick is to put yourself in series with the current. You then can find "trigger" points for electrode placement. Essentially it is used like an ohmeter and you can feel when there is low resistence to the flow of current. This is where the electrodes work the best. There is a very high correlation to the accupunture points. A tens unit works by either providing a counter stimulation to your nerve endings at a higher level of perception, or creating endorphins which are natural pain inhibitors, or what's called the gate theory which keeps the free nerve ending synapse open. Thereby blocking transmission of pain impulse.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Great stuff - knew there was a good chance you'd come through - thanks, as ever, Fox!

Bennette
Posts: 65
Joined: Mar 2012

Thanks for the info.

I looked into the appointment she has on Tuesday with physical therapy and it is in the spine center and they do have the tens as one of their treatment options. So I think I will keep the appointment on Tuesday and just not let them do anything over zealous and discuss the tens treatment with them to see if they think this would be helpful to her. We have to be at the hospital every day for radiation treatments next week, so I won't have to get her out for a special trip. At least now I have an idea of what to talk to them about, thanks to all of you.

Bennette

foxhd's picture
foxhd
Posts: 1855
Joined: Oct 2011

good plan

garym's picture
garym
Posts: 1651
Joined: Nov 2009

Another vote for TENS...I have one and use it all he time for low back issues, I also use an inversion table which I'll keep available for TW to sleep on should he ever visit Michigan.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Depend on it!

Does it have a good rail for hanging from?

With your and Fox's endorsement I'm definitely going to mention TENS to my golf journalist RCC survivor friend with sciatica problem

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Fox, having researched a little on various UK and US sites and noted the comments by you, Donna Lee, Rae and Gary, I'm about to experiment with a TENS/EMS Unit.

I'm not sure I've fully understood your remarks above and would be glad of further help to get the best out of my device. The pain I'm wishing to address is, very roughly, at top end of the (right) external obliques. I'd be most grateful if you could expand your description of the algorithm for placing the electrodes and being "in series with the current". Also, do you have a recommended chart of acupuncture points that might help to fine tune the placements?

Once I've got started I may want to ask you about alignment to muscle fibre orientation but if you happen to think of any other important issues pro tem, please advise.

foxhd's picture
foxhd
Posts: 1855
Joined: Oct 2011

and the positive at position of pain

angec's picture
angec
Posts: 614
Joined: Mar 2012

TW look at the links here and click on them to get some info that may he useful to you in regards to placing the electros for the tens unit.

http://m.youtube.com/playlist?list=PLA2EB2997F408DC50

Don't put the tens on too high a frequency, you should be comfortable, it should not pain you. It must be gentle in that area.

Use this to get an idea of the points /meridians for accupuncture. Although are you really going to attempt that yourself? Too bad you weren't in NY. My acupuncturist is terrific!

http://www.chiro.org/acupuncture/ABSTRACTS/Acupuncture_Points.pdf

Not sure if any of it is useful to you. I guess Fox knows best!

foxhd's picture
foxhd
Posts: 1855
Joined: Oct 2011

Looks like I screwed up my post. The easiest way to set up tens is to place electrodes adjacent to the painful area. Usually along the same nerve root distribution. The idea is to fatigue the free nerve endings and inhibit the pain impulse from being triggered. Or, set the proximal electrode close to spine along the nerve root. The other way that I mentioned was to identify trigger points and use them. They have a very high correlation to acupuncture points. place one electrode near the painful area or near the spinal root, or hand. Hold the other electrode in your other hand and slowly increase intensity until it is felt. Then using your index finger as a pointer, run your finger in the area of the pain. As you approach a trigger point, the resistance to the current is reduced and the sensation goes up. As you localize the point, use it as an electrode placement. You can then repeat this for the other electrode. You can find these same points using an ohmmeter by holding the probes and watching the resistance decrease on the meter.Sometimes the trigger point is not exactly where you feel the pain. That is another discussion. Choosing the neg. or pos. electrode doesn't matter much for pain relief but can influence absorbtion of some topical medications and can affect some edema by attracting or repelling ions. The theories for tens use are that 1) it fatigues nerve endings and slows pain impulse.2)it affects the neural synapse from transmitting pain by keeping the junction open.3) it produces endorphins which are a natural opiate and it overrides pain. The machine setup for frequency, rate of impulse, and intensity are adjustable. You monitor these so that your system does not adapt and neutralize the benefit. Of course each machine varies in capability and adjustability. Experimentation is encouraged.

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