Today's post from cancergrace.org (see link below) is very useful if you have lung cancer or lung problems in general and have contracted neuropathy as a result of the cancer drugs you're taking. It explains the issue simply and highlights the chemotherapy drugs most likely to cause neuropathic symptoms. Whatever your medical history, there is always a possibility that you may end up with a form of cancer and neuropathy is a fairly common side effects of cancer treatment drugs. It's important that you discuss the options with your doctor or specialist.
Published March 2, 2014 | By Dr West
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One of the challenges of cancer care is that we guide our treatments by what clinical trial evidence tells us is best for particular patient populations. However, trials exclude patients who have significant medical issues other than cancer. So what do you do for patients who have lung cancer but also have common medical problems like compromised kidney function or pre-existing numbness and tingling (neuropathy) from diabetes or vascular disease? A purist in evidence-based medicine would say that patients who don’t have good kidney function or who have other medical problems that would exclude them from the trials of our standard treatments can’t get treated, but fortunately most oncologists are more flexible than that. What’s the right way to proceed? The answer is that it falls to best medical judgment. But can we be more specific than that?
In the setting of renal insufficiency, which is common as patients get older, as well as being a result of years of high blood pressure or diabetes, we need to substitute out the treatments that are most threatening to kidney function worsening. Specifically, this means avoiding the particularly kidney-threatening cisplatin, considering avoiding carboplatin (or perhaps giving it and carefully monitoring kidney function and dropping if it kidney function worsens, and then substituting non-kidney damaging agents instead). If kidney function is only minimally impaired, it may be very acceptable to give carboplatin plus a taxane: Taxol (paclitaxel), Abraxane (nab-paclitaxel), or Taxotere (docetaxel)), Gemzar (gemcitabine), Navelbine (vinorelbine), or Alimta (pemetrexed). An alternative, and the leading one if kidney function is quite compromised or gets worse on carboplatin-based chemo, is to give a nonplatinum doublet, which basically means pairing two drugs for lung cancer that are more commonly partners for cisplatin or carboplatin. Common nonplatinum doublets include Gemzar/Navelbine or Gemzar with one of the taxanes. About 15 years ago, there was a significant hope that these agents might turn out to be an improvement from platinum-based doublets, with comparable or slightly superior efficacy and improved tolerability. That didn’t turn out to be the case: the nonplatinum doublets were typically of the same or very slightly lower efficacy, and the same or slightly better tolerability. Overall, they were a lateral move and never took hold as a leading choice, but they are certainly a fine choice and arguably the ideal one for people with limited kidney function.
Then there’s the case of patients with peripheral neuropathy. The taxanes and especially Taxol are the worst offenders here, as is cisplatin, and Navelbine can also worsen neuropathy. Here, we commonly favor carboplatin with a less neuropathy-inducing partner drug, so Gemzar is often a leading choice, or Alimta for a non-squamous lung cancer.
It’s also reasonable to consider single agent chemotherapy, though several recent trials have shown that carboplatin doublet chemotherapy is associated with better outcomes as first line treatment than single agent chemo, even in patients with a marginal performance status. But it’s certainly reasonable to consider single agent chemo in individual patients with significant organ compromise, or simply in patients who are particularly wary about significant side effects.
Though there are certainly other problems that merit individual treatment recommendations, these are among the most common ones. In the end, it still comes down to individualized judgments and considerations of the circumstances of the particular patient.
http://cancergrace.org/lung/2014/03/02/treating-patients-with-other-med-problems/#more-14241
Today's post from health.clevelandclinic.org/ (see link below) talks about shingles, a form of neuropathy that is often not thought of as being nerve damage but if you've ever had an attack, you'll be pretty sure it is. It's cause by the virus varicella-zoster, which is a herpes virus and just like herpes, it will lie low for some time and then strike when your system is also at a low ebb. Most people who suffer from shingles have also had chicken pox at some time in their lives and that's one way the virus enters the body because chicken pox is also caused by varicella-zoster. For people already living with other conditions, including neuropathy, shingles can be doubly painful (and doubly depressing). Fortunately, there is a vaccine available but it won't remove shingles, it will just lessen the impact. For the full story see below.
Ever Have Chickenpox? Then You’re at Risk for Shingles. How to minimize your chances of getting this painful rash December 14, 2016 / By Family Health Team
When you were a kid, did you scratch your way through a case of chickenpox? If so, you met the virus that causes shingles.
Called varicella-zoster, it didn’t leave after your chickenpox faded. Instead, the virus laid low in your nervous system.
For one in three adults, the zoster virus re-emerges decades later as shingles. Each year, about 1 million Americans develop the painful rash. Those over 60 are especially at risk.
“Anyone who has had chickenpox is at risk of developing shingles at some time in their life,” says Daniel Allan, MD.
How shingles develops
Sometimes a headache, nausea, fever or chills will herald shingles’ arrival. And the area the rash will be targeting can become painful, numb or tingly a few days in advance. Once the rash hits, blisters form, along with pain described as stabbing, shooting or burning.
“The initial rash is often confused with insect bites,” says Dr. Allan. ““The pain can show up before the rash, continue through the rash and most importantly, it can continue after the rash has healed up.”
The shingles rash typically appears as a band stretching across one side of the trunk. It can develop elsewhere, however. If the rash goes near the eye, immediate care is needed to avoid eye damage.
The shingles rash often lasts for a couple of weeks
Antiviral medication will shorten the duration and pain of shingles if given right away. “Generally, we recommend that patients see their doctor within two to three days of onset. That’s when the prescribed medications are more effective,” says Dr. Allan.
It’s important to keep an oozing rash covered. You can’t spread shingles itself. But you can spread the virus, which can cause chickenpox in those who haven’t had chickenpox or haven’t been vaccinated against it.
“Anyone with active shingles should also avoid pregnant women because of risk to the fetus,” he adds. “Once all the lesions have scabbed or crusted over, you’re no longer contagious.”
Shingles can strike at any time
Unlike chickenpox, shingles can recur — though not always in the same spot.
Shingles can and does develop in younger people. But it is riskier for older people, who are more likely to develop chronic pain from nerve damage (post-herpetic neuralgia), and for those with autoimmune diseases, because getting shingles increases their risk of stroke.
“There is a shingles vaccine recommended for adults 60 and older,” says Dr. Allan. “This vaccine is extremely useful for reducing your chances of getting shingles, although it won’t eliminate them. Even more importantly, it drastically cuts the risk of developing post-herpetic neuralgia.”
Many patients with post-herpetic neuralgia require treatment with pain relievers, nerve blocks or implanted nerve stimulators to relieve pain.
https://health.clevelandclinic.org/2016/12/ever-have-chickenpox-then-youre-at-risk-for-shingles/
Today's post from petmd.com (see link below) highlights a little-known fact that dogs, cats and other domestic mammals can also suffer from neuropathy. Now if you suffer from nerve damage, you can tell others how you're feeling but even then, it can be difficult describing your symptoms. Imagine then how long a dog or cat might be suffering before you notice something's wrong! They can't tell you and you can't question them! This article provides a list of symptoms to look out for, which is helpful. It's also pretty astonishing to learn that one of the common treatments is Gabapentin, which as you know is also prescribed for humans (with or without side effects). Spare a thought for your pets this festive season - they don't have special orthopedic footware as they walk through the mud and cold but you can imagine what they may be going through if they suffer from neuropathy. If you're concerned, a trip to the vet may be in order. Neuropathic Pain in Dogs Pain from the Nervous System in Dogs
Neuropathic pain commonly results from an injury or disease relating to the body’s nerves and how they function, or within the spinal cord itself. This particular kind of pain is difficult to pinpoint, especially in patients that are unable to respond to specific inducements.
Symptoms and Types
Damage to the tissues of the body, and the nerves running through them, creates a constant (chronic) pain that is brought on by a light touch to the affected area and/or a heightened perception of pain. Pain originating within the spinal cord causes problems with mobility and various functions of the body.
Some of the symptoms of neuropathic pain may include:
Limping or dragging a limb
Shaking or twitching of the skin
Chewing on the affected area
Muscle wasting (atrophy)
Crying out (vocalizing)
Decreased appetite
Urinating and defecating inappropriately (incontinence)
Causes
Neuropathic pain may result from an injury to body tissues or a growth (tumor) in the spinal cord. Diseases that affect the spinal cord, such as intervertebral disc disease (IVDD), may cause pain in different areas of the body, depending on which part of the cord is affected. Another potential cause of neuropathic pain is amputation of a limb. Phantom limb pain results in the impression of pain coming from a leg that has been surgically removed.
Diagnosis
In general, neuropathic pain is diagnosed by ruling out other causes of pain and performing reflex tests to evaluate the nervous system. Basic blood tests can help rule out infectious and disease-related causes. X-rays and special imaging may be necessary to search for tumors in the bone or spinal cord. Finally, a good discussion of your dog's medical history and previous symptoms will help lead to the proper diagnosis.
Treatment
Analgesic medications (those that relieve pain) are used as the initial treatment for neuropathic pain. The amount given may need to be changed until the best effect is achieved. Other types of pain relievers may be tried until the one that works best for your dog is found. Some veterinarians may choose to use several pain medications at one time and then taper off until only one is being given.
One medication that has been used with success for long-term pain is gabapentin. This anti-seizure drug has analgesic properties that are particularly effective for reducing neuropathic pain in dogs. Gabapentin is given once daily for pain control and can be given with or without food. The particular side effects of this drug include sedation, weight gain and stumbling (ataxia). Diarrhea may also be seen in some animals.
Living and Management
Dogs with chronic pain may gain considerable relief from analgesic medications. The quality of life for these animals can be much improved, as long as the underlying condition causing the pain is under control.
In dogs with kidney problems, the dosage of gabapentin may be reduced, as the drug is processed through the kidneys and they must be functioning properly for the drug to be removed from the body. Animals that are pregnant should not be treated with gabapentin. When discontinuing the medication, gabapentin should be slowly tapered off to prevent seizures from occurring after long-term use.
http://www.petmd.com/dog/conditions/neurological/c_dg_neuropathic_pain
