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Issue with Electrolytes

Bill91101
Posts: 60
Joined: Apr 2009

Hi all,
I am wondering if anyone with a history of HT/radiation treatments has experienced issues with low electrolyte levels as a result of their treatments.

My most recent (June 2019) blood panel showed my sodium at 133 millimoles per liter. (Recommended minimum for my age group is 135 mmol/l) Not a cause for concern, but last November I was hospitalized for nausea, headache and chills. A blood panel indicated a very low level of sodium - I think I was told 120 mmol/l. I received IV sodium and oral potassium treatments at the hospital and ran through a gamut of tests which indicated everything tested seemed to be okay.

I’ve felt fine since. Everything else on the blood panel was good (other than low testosterone which is intended). My recent bone scan was good. (Big relief).

What caused the low sodium level is a mystery (to me). The doctors I’ve spoken with have all said it was probably due to dehydration, possibly from the flu. No, I was well-hydrated. I hadn’t had the flu. The very minor diarrhea I had was a consequence of the headache and the nausea due to my low sodium level.

I’ve been on Casodex 50 mg a day since August 2016. I was getting Zoladex injections every three months from August 2016 until August 2018.

This is my second go-round for HT. I had Degarelix and then Vantas injections from May 2009 to late 2012. 42 sessions of IMRT in Summer 2009. No issues with electrolytes at that time.

(A comment Georges made on another thread about getting his sodium/potassium levels checked caught my eye and get me wondering the experiences of others on this board.)

Any feedback will be greatly appreciated!

take care everyone,
Bill

eonore
Posts: 41
Joined: Jun 2017

Hi,

I did not experience this, and a quick google search didn’t turn up anything.  The only thing I can think of is that if you experienced lots of hot flashes, the excessive sweating caused some dehydration.  Pretty far fetched I know.

 

Eric

Bill91101
Posts: 60
Joined: Apr 2009

Hi Eric,
I’ve been doing the Google search, too, but I haven’t seen anything relating the HT/radiation to my electrolyte issue. Vasco recommended I have my thyroid checked out – so, I will be looking at that in a month.
I’m on my second go-round with the HT. Zoladex/Casodex this time; Degarelix and Vantas back in 2009 – 2012. I had some issues with hot flashes after the Degarelix and Vantas injections, but not as bad as some of the guys have reported.
I’ve been pretty lucky as far as side effects from my radiation and HT. Ten years since I was diagnosed and still here.
Take care,
Bill

Georges Calvez
Posts: 244
Joined: Sep 2018

Hi there,

I had an electrolyte analysis way back in September 2017 when I had sodium 143 mmol/L and potassium 3.7 mmol/L.
I started Firmagon at the end of March and had another analysis in January 1019 when I had sodium 141 mmol/L and potassium 3,9 mmol/L
So no significant movement and they stayed inside the normal ranges so no worries yet.
I am going to put transaminases and gamma-glutamyltransferase (GGT) on my laundry list for September!

Best wishes,

Georges

Bill91101
Posts: 60
Joined: Apr 2009

Hi Georges,
Are you getting these tests run to monitor to the side effects of the Firmagon (Degarelix)?
I was on monthly Firmagon injections back in the second half of 2009. My PSA dropped rapidly. I had relatively minor hot flashes, fatigue and injection site pain. Gained some weight despite getting my five miles a day in. Oh, well. I switched to Vantas 12-month depots in January 2010. I didn't have much in the way of blood testing done back then - PSA and testosterone, mainly.
Take care,
Bill

Georges Calvez
Posts: 244
Joined: Sep 2018

Hi there,

I had a bit of a scare early on with Firmagon when my blood pressure rocketed up.
I have now got it under control but I am still a bit nervous about things.
My doctor is willing to write prescriptions for all sorts of blood tests so I tend to ask for things that may not have much in the way of medical value but are interesting.
I have three monthly PSA tests and I had a testosterone test done, I was below the limit of detection.

Best wishes,

Georges

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Bill,

The major effect of ADT in prostate cancer treatment is the disruption of the endocrine system. Once started, hypogonadism sets in arresting with it a hormonal misbalance in the body, which leads to a series of occurrences (parts of our body systems function via hormonal pass-ways). The brain then try to regulate the situation aiming into a more stable function. The hypothalamus and the pituitary control how much hormones are missing and how much are required sending down orders to the glands to stop production or produce more of the stuff. Something must substitute the missing testosterone, which, in those taking LHRH agonists or antagonist (Leuprolide, Goserelin or Degarelix) that deplete the pituitary Luteinizing hormone (LH stimulates testosterone production) means to have the Thyroid and Adrenal glands active in supplying missed androgens. Some of the system will have to endure and try function with lesser quantity of hormones. The effects can be verified in the blood panel itemization and by the symptoms we experience.

The endocrine system integrates the hypothalamus, pituitary, thyroid, parathyroid, adrenals, pineal body, the testes and the ovaries. Not all members become an issue in PCa patients. The most affected are a disrupted pituitary, thyroid and adrenal glands, and, in long periods of the condition, it lead to deterioration of the liver, kidneys and cardio issues. Diabetes is also a possible result.

In my lay opinion your low sodium levels (hyponatremia) was a consequence from the lack of T3 (triiodothyronine) and/or T4 (thyroxine), which may have been a direct cause of the disruption at the pituitary for not sending down the signaling TSH due to the timing of the LHRH medication. The gland may have become underactive for a period.
In fact we notice the disruption when experiencing hot flashes. T3 and T4 regulate our body's temperature, metabolism and heart rate. All conditions included in my above listed ADT side effects.  Headache and the nausea are common facts of the issue too.

In regards to your above post, I noticed that something seems not rightfull. You say; "... Everything else on the blood panel was good (other than low testosterone which is intended) ....", but you comment that Zoladex injections were stopped in August 2018. Such should result in normalization of the testosterone level to above 250  ng/dL. Can you share the result of the test?
Bicalutamide (Casodex) doesn't interfere with the production of testosterone. It works at cell's receptors by prohibiting these from absorbing the real androgens. Surely it affects all cells in general (not only the bandit) disrupting to certain extent functions dependent on the endocrine system. In any case, your testosterone should have recuperated, now at more than 12 months since the loss of the effectiveness of the last Zoladex shot. The bandit is not happy without testosterone cocktails but such wouldn’t be in your favor too as the hypogonadism condition reflects in the deterioration of other healthy parameters.

I recommend you to check the levels and try stabling the issue to the best you can. Diets and physical exercises are simple and effective ways to regulate things out.

Best wishes,

VGama

 

Bill91101
Posts: 60
Joined: Apr 2009

Hi Vasco,
Thanks for the information and, in particular, the reminder on the role of Casodex in HT.
I reviewed my two recent blood tests for testosterone level - it has approximately doubled in the last three months.
March 2019: 17 nl/l
June 2019: 33 nl/l
I am thinking the effectivity of my last Zoladex injection ended in early November 2018 – 90-day depot injection in early August 2018. No testosterone measurement was done at that time.
I had a number of tests run at the hospital in an attempt to figure out what was causing the headaches and nausea. Testing included liver, kidney, gall bladder function, a colonoscopy, a CT scan of my head (showed nothing), but I don’t recall any tests for thyroid function.
Once my electrolytes were brought up to normal, the headaches and nausea went away, but the root cause of those symptoms hasn’t been satisfactorily explained.
I am now curious about T3 and T4 levels, per your recommendation. I am seeing a new general practitioner, starting in August. I will talk to her about being tested for T3, T4 and any other indicators of thyroid function.
Thanks again!
Bill

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Bill,

Your testosterone is beautifully within the normal parameters. What did you meant by saying that the testosterone was "low which is intended". I envy your 33 nmol/l (950 ng/dL) which is must higher than mine now at the 400 ng/dL mark. You got the energy and power we all want to have at the 70th. I wonder what you have done to grow from 17 nmol/l (490 ng/dL) in just three months. What's the secret? 

Regarding the subject of the thread, I will add that most of the doctors attending PCa patients do not include tests that are usually done for women common issues. Hormonal levels in the body and vitamins are rarely checked by usologists, even knowing that they are the ones propelling us to ADT therapies. I started to include in my blood work (since 2010 when starting ADT) those items I thought would be influenced by the hormonal treatment. Apart from the bone density scan (DEXA) and the common blood and liver markers, I begin testing the testosterone, the creatinine and filtration rate (GFR%) at the 24 hours, adding the thyroid's T3, FT4 and TSH.

I took them as preventive measures. I found I had osteopenia (-1.2) and that was slightly aggravated while on hormonal therapy. The kidneys were affected reaching CKD level 3 by 2017. I saw worsening of the numbers since 2011 but I cannot claim it to be a direct cause of ADT as I also had HBP (taking BP mild drugs since 2000). HBP can damage the tiny vessels filtrating creatinine and urea at the kidneys. Ironic as it can be, the blood pressure which is regulated by hormone pass-ways, need a well functioning kidney to propel the manufacturing of the enzyme Renin that plays an important role in the control of the blood pressure.
Regarding the thyroid, all three markers (T3, FT4 and THS) have fallen within normal levels along the years (2011; 1.15/0.90/1.58) (2019; 0.99/0.86/1.28). In fact I was one of those ADT patients that experienced numerous side effects but mild. Hot flashes (a direct cause of thyroid function) were rare and lasted less than 2 minutes at occurrences. 

Urologists and other specialists tend to treat by symptoms. They may have a look at the blood panel markers but will act only if symptoms persist. They do not act as preventive physicians. The testosterone is one evident example on the issue. Surely no one can verify the proper function of a LHRH agonist without testing the testosterone, but urologists never request such a test. They use the PSA to check the treatment effect only. A rise in PSA could be taken as refractory of the shot erroneously. The surge of the PSA could be due to a bad administered shot which would lead to a rise of the testosterone taking with it the PSA. Repeating the shot one may see a decline of the PSA again.
In my case, the influence of the testosterone in the PSA levels was highly significative. I saw both markers getting low for the effect of the shot and later rising accompanying each other once the effect of shot dissipated. This happen until the markers reached a plateau. Later I saw that the PSA climbing continuously while the testosterone maintained a sort of constant level. Fortunately to me the rise of the PSA has been sluggish providing me a long period off drugs.

You may find interest in the contents of these links;

https://www.msdmanuals.com/en-pt/home/hormonal-and-metabolic-disorders/pituitary-gland-disorders/overview-of-the-pituitary-gland

http://www.yourhormones.info/glands/kidneys/

Best wishes,

VGama

Bill91101
Posts: 60
Joined: Apr 2009

Hi Vasco,
“Houston, we have a problem.”
My secret was to use the wrong units! (Works every time. Though I’m not sure where the other units came from. My wife thought it was pretty funny since ‘I are an engineer’.)
Testosterone readings should be:
17 ng/dL for March 2019
33 ng/dL for June 2019
The increase in testosterone makes sense considering I’ve stopped Zoladex treatments and have been taking Casodex, only.
In addition to PSA and testosterone, I’ve been going in for expanded blood testing over the last few years: CMP (comprehensive metabolic panel) and CBC (complete blood count). The CMP includes tests to evaluate kidney and liver function; CBC looks at various blood components. No thyroid function testing performed.
The test lab I use reports ‘normal range’ results with green highlighting and ‘out of range’ with red. My latest report is all green, except for sodium and testosterone.
My current oncologist ordered the above blood work. Otherwise, the blood tests have been ordered by my general practitioner. The urologists/oncologists I’ve consulted previously have been PCa-centric. The urologist who first diagnosed me looked at the effect of the HT on my testosterone levels and was concerned with how it affected other aspects of my life. I’m switching medical groups in hopes of a referral back to him.
My November 2018 ‘low-electrolyte’ hospital experience reminded me I could possibly die from something other than PCa.
Excellent advice to consider expanding the testing performed to include thyroid and maybe some other parameters. I had a diabetes check about two years ago – all was well in that department. But couldn’t hurt to look at again.
I’ve seen my testosterone and PSA drop/rise in conjunction with my receiving treatments. I had a good vacation from 2012 until mid-2016.
Take care,
Bill

Bill91101
Posts: 60
Joined: Apr 2009

Vasco,
And thanks for the links to the two sites!
Bill

Georges Calvez
Posts: 244
Joined: Sep 2018

Hi there,

I would second what Vasco said, my urologist is very prostate cancer and PSA focused.
He is not that worried about the level of testosterone, blood sugar, blood pressure, etc.
If I die of anything but prostate cancer it is a win, if prostate cancer does nor recur it is a win, the longer I live the better as long as the prostate cancer is controlled.
He has one eye on me and one eye on the revenue stream, keeping the bean counters happy and staying up in the hospital league table.
That is why I am off to my local friendly médicin traitant to talk about other issues next week.

Best wishes,

Georges

Bill91101
Posts: 60
Joined: Apr 2009

Hi Georges,
When I was first diagnosed with PCa in 2009 my urologist commented “at least you know what’s going to kill you.” Not very encouraging, but I responded very well to radiation and HT. He was very surprised and very happy for me. Asked my permission to include my case in a paper he was working on. But I’m not sure what happened in that regard.
When I was hospitalized last November for what turned out to be low electrolyte levels I thought: “what the heck? Where did this come from?” I assumed the low levels were a result of my PCa treatments but started to wonder if it was something I hadn’t been paying attention to. I’ve discussed the results of the various tests I underwent with my general practitioner, an oncologist, urologist, a gastroenterologist, emergency room and hospital personnel and they all agreed it’s a real head-scratcher.
I should be able to request further blood tests from the new general practitioner I’m going to in August.
I agree with the warning about urologists and their focus. I’ve been to three: one very good, one horrible and one so-so. Only the first looked into any effects other than PSA response. I liked the radiation oncologist I went to, but he only looked at PSA - though I did fill out a questionnaire and spoke with a nurse at each visit about bladder function.
Good luck with the future doctor visits. Here’s hoping you get good test results.
Bill

Steve1961
Posts: 234
Joined: Dec 2017

 going to see my GP after one year.i love this man I should have listened to him about surgery .anyway I want a full blood screen ..what do I ask for and what do i look For in any abnormalities in blood work after radiation ..do I ask for the whole chabang and look to see if anything is low thanks 

 

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Steve,

Get a total blood panel including the analysis of urine from 24 hours. This means that you have to gather the whole urine during 24 hours to calculate filtration rate, etc, by volume. Typically one should check: The Heart, Thyroid, Circulatory System, Liver, Kidneys, Glands, Nerves, Bones and Muscles

Read these links;

https://ada.com/blood-test-results/

https://www.lifeextension.com/Magazine/2006/5/report_blood/Page-04

Best,

VG

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