The difference between steroids like Dexamethasone and Medrol Dose Pack, plus radiation of lymph nodes behind the trachea.

[Bluebird11]

My cousin's husband is undergoing radiation. They are giving him 13 spot radiation treatments in a few areas. They found some lymph nodes behind his trachea which they are radiating.

They also are radiating 3 thoracic vertebrae, 5, 6, and 7. They are doing all the radiation at one time.

I have a lot of questions about the steroids he is taking.

Then I have questions about the lymph radiation and the vertebrae radiation.

First, the radiation was ordered and begun. He was given no steroids at the beginning of his treatments. He also is not given anything to mitigate inflammation or anything when he began treatment. He is 76 years old.

On the second day he began vomiting, so, I asked my cousin to check with his radiologist about something for cutting down inflammation. I thought maybe his esophagus might be having spasms from the radiation. He did have vomiting prior they thought because of the enlarged lymph behind the trachea.

My husband went through radiation, this is why I have some experience with it. He had radiation on L4. His radiation oncologist began him on dexamethasone, 2 ml, 2 times a day. This is why I questioned why there was no discussion for trying to reduce or mitigate inflammation from the radiation right from the beginning.

When she asked on the 3rd day, he was given Medrol Dose Pack 4mg, for a 7 day pack. His radiation involves 13 days.

I know nothing about Medrol or the dose. I do know when my husband did radiation his oncologist initially ordered steroids because of sciatica pain prior to radiation, which turn out to be way too high a steroid of Dexamethasone. 4ml, 3 x's a day.

Our radiation guy immediately gave us a prescription for a 2ml, 2 times a day, which he thought was enough. Now, with that 2 times a day, it took us months to wean off of this, going down to 1ml, 2 times a day and all the way down to 1/4 tablet.

Also, we dissolved it towards the end and used it in drop form.

My husband actually liked the energy he got from the steroids. It took him quite a while to wean because fatigue set in as he was lowering the dose.

My questions are about what I've discussed above. Dex vs Medrol, and a 7 day pack while he's going to be doing radiation 13 days.

All of his radiation will be behind the trachea and in the thoracic area, involving soft tissue. When would each be used and why. I did see where Medrol is used for vomiting. But, my question involves the inflammation radiation causes that can be difficult to deal with.

Can we have a discussion about any experiences you've had with either radiation in the lymph behind the trachea. This is an area I'm not familiar with, and/or then 3 vertebra at a time. T5/6/7.

Also, anything you've done to help ease the inflammation. He really can't keep food down. He is in a rehab facility for now, and hoping to go home.

He didn't do well on Xtandi. It was a tough drug for him. He will try Zytiga once he stabilizes a bit. We have to get some of his symptoms straightened out. He's having a lot of confusion. He was at first given Adivan which caused confusion. Now we are trying to figure out what else might be causing confusion.

He is also taking Metformin, which he started at the same time as Xtandi 4 months ago. So, this is a new drug for him.

There's a lot converging, which we are all used to dealing with prostate cancer.

I was going to post this in 2 posts, but, got ahead of myself. Thanks, sorry if it is disjointed. I appreciate all of you.. much gratitude.. genie

[Bluebird11]

OMG.. so sorry it is this long.. I didn't realize it..

[Hidden]

Your cousin's husband is getting radiation on his neck for bone mets and lymph node mets there. You have some questions about steroids - like would they help prevent vomiting. Is that it?

[Bluebird11 in reply to Hidden]

Any one who has had lymph nodes radiated around the trachea?

Anyone who was given this Medrol 7 day pack?

Why just 7 days when radiation causes inflammation?

Our doc put my husband on steroids at the onset of his radiation to mitigate the inflammation.

What is the difference between Medrol and Dexamethasone?

And. what can be used to mitigate side effects of the radiation?

Thanks.. sorry, for my initial rambling questions.

Genie

[Charlean]

My husband had radiation to the T2, 3 ,4 vertebrae and cervical vert. and they did it from the back, side and front, which basically fried his esophagus. 12 treatments. He began coughing up phlegm and frothy stuff, coughing very hard and then couldn't swallow, starting choking on even water. After two days and two visits to Drs, we were told he would be fine but he ended up with a fever and couldn't swallow anything so I took him to ER anyway. He ended up in the hospital for 11 days, with lung embolisms, aspiration pneumonia, deep vein thrombosis, and couldn't swallow for the entire time, almost had feeding tubes put it. He did not get any steriods until later when they did the base of his skull. It was dexamethosone for any brain swelling. We also had to do the tapering but it went ok. He did have some problems with his blood sugars. Be very cautious and ask if they are going through the front. Another Dr told us there is palliative radiation and curative and one is much stronger. We should not have had the curative because he was very progressed in his disease at the time, already suffering paralysis. I wish him good luck with the treatment. At his age, this might be very rough.

[Bluebird11 in reply to Charlean]

Charlean, here you are again... sharing so freely. Oh, what you and Harley went through! I'm so sorry he had to go through so much, and that you had to witness the suffering. It's a rough thing for the strongest of us to bear. In a relationship, we do know that one will witness the other leaving. Not easy.

So, I should ask about going through the front?

Also, honestly, after a few people's experiences, and ours, I can't imagine how, and why, steroids aren't given right from the start to keep down the inflammation and pain. I know, weaning is tricky. I also learned that our initial dosage was way too strong, 4ml, times a day.. which is 12 ml.

My husband did very well on 2 ml, 2 times a day. And, even at that, weaning took a long time. We were lucky he was given steroids. Dex is a tough drug.

Yes, the curative and the palliative- I will ask her to ask that question.

I understand so much more of what you and Harley went through, and, I am greatly appreciative of your generosity, which you always have had.

You were the first one to caution me about my husband's L4 situation. We acted on it immediately, and sure enough, saved him from a spinal compression. I will always be grateful and love you, for this. Thank You.

I'll pass this one to my cousin. She is more angry at this point, because, I believe, this happened very quickly, and is in shock. Also, she's alone, and her husband isn't the type of guy who is willingly doing things to help him.. He does go in an out of a lot of confusion...

Blessings and great respect... Genie

[Charlean in reply to Bluebird11]

Genie, thank you for telling me that I helped you. It feels so good to think that I could help even one person from such a horrible fate as spinal cord compression. That is my only purpose for sharing, to prevent others from suffering the mistakes and misery that we endured. I totally understand the anger. That is something we all go through. I still have days where I am angry. It is such an insidious disease.

One more thought here. My husband had really bad side effects from Xtandi as well as Zytiga, but also, neither worked very long term for him. I guess my point is, if he had problems with the one, he very well may with the other. Hopefully not, but just our experience and I believe several others have said the same thing. Keeping you all in my prayers. Hope you have a peaceful holiday.

Charlean

[rococo]

An internist once told me to go easy on the ativan. It has an adverrse effect on cognition and can lead to early dementia. I only take it as needed and at very low doses.he said lexapro better. Of course have less issues to deal with.

[Bluebird11 in reply to rococo]

Thanks for that. 💖

[Hidden]

I have had two palliative radiation treatments to my thoracic spine. First time 15 treatments to T4-T10. Second time 10 treatments T1-T3. No steroids required. Both times I had minor irritation to throat post treatment.

When receiving radiation of any kind it is the combined skill of the radiation oncologist to plan correctly and the radiation techs to operate the machines that is vitally important to reduce side effects.

No experience with lymp nodes behind the trachea.

Bill Manning

[Bezil1429]

Genie, God bless you and your cousin's husband. I believe I may be just one step behind where he is.

My experience since becoming a "failure" with Zytiga - (it never worked for me) - my PSA has continued up steadily (from 17 to 38) through my 6 months taking Zytiga.

So, I am now starting Xtandi, but I'm not too optimistic. I believe I am genetically resistant to these two drugs.

Now my Oncologist is considering a new "bone scan" to see if there are any "hot spots" (lymph or bone) that may be causing the persistently rising PSA. 6 months ago my bone scan was "unremarkable".

Aside from the PSA threat, I have no pain, nor have they discovered why the PSA continues up. So my case remains a puzzle, but I fear at some point they will want to zap PC "spots" that are supplying the targets - causing the rising PSA - as with your cousin's husband.

I have no treatment advice to offer - I took prednisone (.5 mg twice per day) with Zytiga, and it seemed harmless. I'm told it is a low dose.

Could you tell me where your husband is being treated? I am considering a change of oncologist, and Iam seriously considering a change of "providers" such as Memorial Sloan Kettering that "thinks" newer treatments, and have dozens of oncologists and tons of PC experience.

Anyway, best of luck for your cousin's husband. Seriously consider a change of provider - get a second &/or third opinion. I, personally am wary at what's happening with this treatment. Be sure to get a broader base of opinion!!. Bruce