Need a little advice please

[Angie Daughter of Bill]

I know that Dr. Joe is on vacation right now, but I will go ahead and post this. Maybe Teresa or John can help me out. (or Dr. Joe can pick up on it when he returns from his well deserved vacation )

My question is..........Can a patient have brain mets and not have very many symptoms? My Dad has been having some dizzy "spells". It happens about twice per week. It started about two weeks ago. The last one that he had, he was sitting in his truck, got out, walked around to the front of the truck, felt as if things were going dim.........he ended up tripping and falling flat on his face! Poor thing! Could brain mets present themselves with dizziness alone? No headaches, no balance problems(except when he got dizzy and fell), no speech changes, etc.

A little background.........right now Dad is getting radiation to the T12 and left hip. He is not on chemo right now. His meds include Oxycontin 40mg twice daily, Lortab 7.5 for the breakthrough pain, Folic Acid tablets and B12 injections(gearing up to start Alimta on Dec. 3rd), Miralax for constipation and Megace to increase his appetite. My first thought other than brain mets was the Oxycontin. But, he takes the Oxycontin everyday, twice daily and the dizziness does not happen every day. If it was brain mets, would he have the symptoms every day? Or if it is a small met, could it happen just every once in a while? I take his BP several times a day.........it's always in the normal range. I have even taken it when he was feeling dizzy. It was normal.

I will talk to the doctor about this, but I don't want to jump to conclusions. Also, I have read that squamous cell carcinoma is the least likely to met to the brain. But, how often do you actually see squamous cell met to the brain? Does it sound like an MRI would be in order or would that be jumping the gun?

Whew........it is so hard to find a balance. I want Dad to get EVERYTHING checked out and he doesn't want to call the doctor for ANYTHING. (He feels that it is a bother every time I call asking questions about his symptoms........he says he can wait until his next appointment......of course I call anyway most of the time)

Thank you guys for all the time that you take answering my neurotic questions!!

Angie

[Angie Daughter of Bill]

After researching, I also found something else that could be a possibility. What about hypercalcemia? The symptoms which I found were dizziness, constipation, weakness, urinary frequency and sleepiness. Dad has all of these symptoms. Maybe this could be a possibility.???? Dad's doctor did not mention anything out of the ordinary on his last lab report though. hmmmmmm...........still would like to know if a brain met could present as dizziness. Thanks!

You guys are so awesome to volunteer your time.

Angie

[john]

I would talk to his Dr about your concerns. I think it could be a number of different things. Hopefully, Dr Joe can provide futher insight.

Here are my thoughts but take them with a grain of salt because I am not a Dr, and even if I was, I don't think any dr can diagnose anything through a message board.

I think the Zometa should keep the calcium levels normal.

Dizziness could be a symptom of a brain met. You do need to talk to his Dr.

The fact that he got dizzy when he stood up from the truck might mean it is related to a positional change. Does the dizziness happen only when he stands up?

I read Zometa can cause dizziness.

If he is not eating well it could be low blood sugar.

If there are lesions in the cervical spine this I think could cause dizziness

Maybe some problem with his heart

Megace can cause dizziness

What are the possible side effects of megestrol?

• Stop taking megestrol and seek emergency medical attention or call your doctor immediately if you experience any of the following serious side effects:

· an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

· sudden severe headache;

· changes in vision; or

· numbness or swelling in an arm or leg.

• Other, less serious side effects may be more likely to occur. Notify your doctor if you experience

· nausea or vomiting,

· dizziness,

· mild shortness of breath;

· weakness,

· headache,

· menstrual bleeding,

· hot flashes or sweating,

· decreased sex drive, or

· insomnia.

• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

[kimblanchard]

Angie, intermittent dizziness can be a tough symptom to find the root cause of because there are so many things that can contribute to it. While you certainly can never say never, what you are describing would be a pretty unusual symptom of brain mets so I think that is less likely. It sounds most like orthostatic hypotension which is a positional drop in blood pressure. Basically, if you go from lying/sitting to standing the effect of gravity makes your blood want to pool in your legs and can cause a temporary drop in blood pressure leading to light headedness and sometimes fainting. Lots of things can contribute to it including poor fluid intake, old age and medications. Does the symptom seem to usually strike when he has gone from sitting to walking/standing? This can be checked by doing a blood pressure and pulse first lying then standing and see how much they change.

The other important cause of intermittent dizziness is cardiac arrythmias or abnormal heart rhythms. These are often but not always accompanied by funny fluttering in the chest. Have him check his pulse next time he is feeling light headed to see if it is abnormally fast or slow.

Anyways, this doesn't have to be directly related to his cancer, make sure he brings it up at his next doctors appointment.