Elevated D-dimer,negative scans

[Appraiser]

Hi Guys

Last week I went to bed feeling fine and woke up in the middle of the night sick to my stomach, dry heaves, vomiting and started sweating like crazy but only for a minute or so. Ended up at the ER where they did a cat scan of the stomach and diagnosed me with a case of enteritis......fast forward to this week, I had a scheduled appointment with my heart doctor for palpitations and a check of my mitral valve prolapse. In my conversation with the good doctor I mentioned that i sometimes had a bit of breathing difficulty, not bad just a bit labored. We did a D-dimer which came back at 1.99. They immediately did a chest scan and ultrasound of both legs. Doctors nurse called tonight with the results stated that both tests came back negative with the chest scan showing a bit of Emphysema accounting for the breathing problem....I guess. I questioned the high D-diner but was told “they don’t take it any further” and that they would check it again in a year. I will be following up with my own Primary care physician as well as my oncologist whom I see in August when it’s time for a cat and bone scan.....I’ve been taking .5 mg of DES for 5 years now along with baby aspirin so I’m not that surprised by the high D-dimer. Ive maintained a PSA of .5 with higher than normal testosterone and for someone with a Gleason 9 cancer diagnosed in 2004 It’s been a great ride (except for the Gynecomastia which drives me nuts). My question, has anyone else had these D-dimer results with negative scans and any suggestions on lowering that number

Thanks Guys

Joe D

[Tall_Allen]

Here are a couple of things to discuss with your oncologist:

1. using a patch or transdermal cream rather than a DES pill

2. Take 20 mg/day tamoxifen to reverse gynecomastia and 10 mg/day to prevent it

[Appraiser in reply to Tall_Allen]

Thanks Tall Allen

Does the tamoxifen stop the affects of artificial estrogens from lowering PSA

[Tall_Allen in reply to Appraiser]

No. It just blocks estrogen in breast tissue.

ncbi.nlm.nih.gov/pubmed/225...

It is widely used by men taking bicalutamide because anti-androgens cause testosterone to accumulate. The excess testosterone gets metabolized into estrogen, which acts of breast tissue, causing it to grow.

Transdermal estrogens don't cause clots the way pills do. The peaks in estrogen caused by taking pills make the liver put out higher levels of clotting factor.

[Appraiser in reply to Tall_Allen]

Probably a dumb question but how do you determine the equivalent of .5 mg of DES when using the transdermal cream or estrogen patch

[Tall_Allen in reply to Appraiser]

Not at all a dumb question - it depends on the skin penetrance of the vehicle and the kind of estrogen used. In the PATCH trial in the UK, they treat newly diagnosed hormone sensitive men.: "Each patch contains 3 mg of estradiol hemihydrate in a patch size of 30 cm2, releasing 100 micrograms of estradiol per 24 hours." They change the patch twice weekly.

clinicaltrials.gov/ct2/show...

I know that different types of estrogen are used as female contraceptive patches, but I have only known men with prostate cancer to use estradiol patches. Perhaps ronronHU or Wassersug may have some advice about this. You can send them a chat message.

Your doctor may wish to consult with a compounding pharmacy to tailor the dose of estrogen to your needs. Because individuals vary in their skin penetrance, I think this is something you'll have to experiment with, monitoring your serum testosterone level until the right dose is found for you.

[Appraiser]

Thanks Nalakrats

Just started taking Nattozyme 2000fu. Don’t know why I ever stopped

[pjoshea13 in reply to Appraiser]

D-dimer can be elevated for other reasons, but the assumption is that there may be a clot. And that's even more likely in cancer patients.

1 mg DES (let alone 0.5 mg) is not generally associated with elevated clotting risks. Years ago, PCa patients were getting 5 mg & up, & clotting was an issue.

Regarding nattokinase: the correct dose is the lowest amount that keeps D-dimer at the lowest level (zero, if the lab measures that - LabCorp doesn't.) You might need more than the basic 2,000 FUs. But D-dimer needs to be monitored until that dose is arrived at.

Tests are on sale at LEF at the moment (if you are in the U.S. & in a state that permits.)

-Patrick

[Appraiser in reply to pjoshea13]

Thanks Patrick

Any suggestions on which Brand works best. Right now I’m using up some NattoZyme that I’ve had for some time

[pjoshea13 in reply to Appraiser]

I used Nattozyme for a number of years. I know that it works (I used it against as active clot.)

However, I can no longer find steep discounts, so I switched to Doctor's Best. All I can say is that my D-dimer has been under control while on it.

-Patrick

[Appraiser in reply to pjoshea13]

Thanks again Patrick