Feeling dizzy and lightheaded - Advanced Prostate...

Advanced Prostate Cancer
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Feeling dizzy and lightheaded

Ive just had to take my husband upstairs to lie down, for about the last four hours he has felt dizzy and lightheaded. The only medication that he is on now is Lupron jab every 3 months. Finished RT several weeks ago.

This also happened about 3 weeks ago, so while we were at the hospital they took his blood pressure and every thing was fine.

It says on the literature that Lupron can cause mild lighthead, and nausea, has any one else experienced this and if so how did you treat it, im thinking about ringing our GP first thing.

Ive cut out most of the sugar from our diet,could this be a factor ?

Grateful for any advice

Kim

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Not a dr. I would ring GP if he gets any worse. See what he says. Better safe than sorry. Let him eat whatever he wants for a week. My fridge is full of Dreyer ice cream cause of a special going on. I am jumping up and down with joy. Disclaimer: some say dairy is bad for prostate cancer. I am testing that theory.

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thankyou

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"My fridge is full of Dreyer ice cream"

I'll be right over...........

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/05/2019 5:14 PM DST

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I am coming too, I got chocolate syrup.🤠

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Sure...........

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/05/2019 5:55 PM DST

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Me too

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Ice cream? Eeeeeeeeeeehaaaaa. I'm in. Chocolate Chip please.

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Keep track of his pulse and blood pressure.....increase fluid intake util he sees his doctor and that should be sooner. show his records to his doc calling GP is good idea.

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Yes increasing his fluids thankyou

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Kim,

ADT therapy, such as Lupron, reduces the red blood cell [RBC] count & can cause anemia or near-anemia.

"Erythropoiesis" is the process by which red blood cells are made.

"As androgens stimulate erythropoiesis, ADT is associated with a reduction in hematocrit, which in turn contributes to fatigue and related morbidity." [1]

RBCs carry oxygen & a shortage of RBCs therefore limit physical activity.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/303...

Am J Physiol Endocrinol Metab. 2018 Dec 1;315(6):E1185-E1193. doi: 10.1152/ajpendo.00272.2018. Epub 2018 Oct 16.

Mechanisms responsible for reduced erythropoiesis during androgen deprivation therapy in men with prostate cancer.

Gagliano-Jucá T1, Pencina KM1, Ganz T2, Travison TG3, Kantoff PW4, Nguyen PL5, Taplin ME6, Kibel AS7, Li Z1, Huang G1, Edwards RR8, Nemeth E2, Basaria S1.

Author information

Abstract

Androgen deprivation therapy (ADT) is a mainstay of treatment for prostate cancer (PCa). As androgens stimulate erythropoiesis, ADT is associated with a reduction in hematocrit, which in turn contributes to fatigue and related morbidity. However, the mechanisms involved in ADT-induced reduction in erythropoiesis remain unclear. We conducted a 6-mo prospective cohort study and enrolled men with PCa about to undergo ADT (ADT-Group) and a control group of men who had previously undergone prostatectomy for localized PCa and were in remission (Non-ADT Group). All participants had normal testosterone levels at baseline. Fasting blood samples were collected at baseline, 12 wk, and 24 wk after initiation of ADT; samples were obtained at the same intervals from enrollment in the Non-ADT group. Blood count, iron studies, erythropoietin, erythroferrone, and hepcidin levels were measured. Seventy participants formed the analytical sample (31 ADT, 39 Non-ADT). ADT was associated with a significant reduction in erythrocyte count (estimated mean difference = -0.2×106 cells/µl, 95%CI = -0.3 to -0.1×106 cells/µl, P < 0.001), hematocrit (-1.9%, 95%CI = -2.7 to -1.1%, P < 0.001), and hemoglobin (-0.6 g/dl, 95%CI = -0.8 to -0.3 g/dl, P < 0.001). Serum hepcidin concentration increased in the ADT-group (18 ng/ml, P < 0.001); however, iron concentrations did not change (-1.1 µg/dl, P = 0.837). Ferritin levels increased in men on ADT (60 ng/ml, P < 0.001). Iron binding capacity, transferrin saturation, erythroferrone, and erythropoietin did not change. Nine men undergoing ADT developed new-onset anemia. In conclusion, reduced proliferation of marrow erythroid progenitors leads to ADT-induced reduction in erythropoiesis. Future studies should evaluate the role of selective androgen receptor modulators in the treatment of ADT-induced anemia.

KEYWORDS:

anemia; bone marrow; erythroferrone; erythropoietin; hepcidin; leukopenia

PMID: 30325657 PMCID: PMC6336960 DOI: 10.1152/ajpendo.00272.2018

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What’s the best way to combat this ADT induced anaemia / near anaemia? Or is there little that can be done about it? Husband has this too - somewhat low RBC, haematocrit and also iron. Thanks for any suggestions.

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I had some light-headedness after a few weeks on Lupron/Zytiga, and I started eating beef liver once a week, and it seemed to help a lot to build my RBC count up. Now I only feel light-headed a day after a Lupron shot.

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Here is Dr. Myers on amemia & iron:

askdrmyers.wordpress.com/20...

He talks about hemoglobin, whereas I wrote about red blood cells. RBCs carry the hemoglobin. A low level of hemoglobin is due to a low RBC count, & in the context of ADT, that is directly due to very low testosterone.

It's interesting that liver seems to have helped you. It's a very good source of iron, of course, but also many other nutrients. According to Myers, the iron should not have helped.

-Patrick

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The Myers clip was very helpful. I did take an iron supplement occasionally which always made me feel out sorts. As always, thank you for posting. Phil

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Most likely in my case, eating liver addressed B12 deficiency from eliminating red meat from my diet after PCa dx. Since eating liver I can breathe again in workouts.

"Here are the nutrients found in a 3.5-ounce (100-gram) serving of beef liver (1):

Vitamin B12: 3,460% of the RDI. Vitamin B12 helps the formation of red blood cells and DNA. It is also involved in healthy brain function (2).

Vitamin A: 860–1,100% of the RDI. Vitamin A is important for normal vision, immune function and reproduction. It also helps organs like the heart and kidneys function properly (3).

Riboflavin (B2): 210–260% of the RDI. Riboflavin is important for cellular development and function. It also helps turn food into energy (4).

Folate (B9): 65% of the RDI. Folate is an essential nutrient that plays a role in cell growth and the formation of DNA (5).

Iron: 80% of the RDI, or 35% for women of menstruating age. Iron is another essential nutrient that helps carry oxygen around the body. The iron in liver is heme iron, the kind most easily absorbed by the body (6, 7Trusted Source).

Copper: 1,620% of the RDI. Copper acts like a key to activate a number of enzymes, which then help regulate energy production, iron metabolism and brain function (8).

Choline: Liver provides all of the Adequate Intake (AI) for women and nearly all of it for men (AI is used because there is insufficient evidence to set an RDI). Choline is important for brain development and liver function (9Trusted Source, 10)."

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Thanks for the suggestion. I think because he has been very careful to reduce his red meat intake that perhaps it has caused his iron to drop just under the reference level. Perhaps a little more would be a good idea.

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It could be B-12 deficiency from eliminating red meat is causing more of an effect than iron deficiency from ADT.

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Thanks for suggestion, but B12 is good. Maybe iron is low because of less red meat?

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It could be diet is causing anemia more than ADT since you've eliminated red meat. You may also try adding kale and spinach.

"Common causes of iron deficiency include inadequate iron intake due to poor diet or restrictive diets, inflammatory bowel disease, increased requirements during pregnancy and blood loss through heavy periods or internal bleeding."

"Eat Iron-Rich Foods

If your doctor thinks your iron deficiency may be caused by a lack of iron in your diet, think about consuming more iron-rich foods, such as:

Red meat, pork and poultry

Dark green, leafy vegetables, such as spinach and kale

Dried fruit, such as raisins and apricots

Peas, beans and other pulses

Seafood

Iron-fortified foods

Seeds and nuts

Help Boost Your Iron Absorption

Importantly, eating vitamin C will help your body absorb iron better. Make sure you eat enough vitamin C-rich foods, such as fruits and vegetables (24Trusted Source).

It may also be beneficial to avoid certain foods that can inhibit iron absorption when eaten in large amounts. These include tea and coffee and foods high in calcium such as dairy products and whole-grain cereals."

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That’s great info. Thanks. Much appreciated.

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Yes iron could be another course of course. But I think that for now monitoring his fluid intake and his blood pressure and pulse are the best things to do before you can discuss it with your oncologist and GP.

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With a low RBC count, the oxygen delivery rate depends on how often the RBCs go back to the lungs to pick up more. So perhaps, the mildest of physical activity, sufficient to increase the heart rate, might help?

Nalakrats had something interesting to say in this post:

healthunlocked.com/advanced...

& I posted something 2 years ago:

healthunlocked.com/advanced...

-Patrick

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Thank you Patrick. As always we appreciate your knowledge and your willingness to share it. We feel we can always count on you to help us and others on this forum.

My husband stays pretty active which is a good thing and as you say can help to oxygenate the blood, but I think perhaps he also needs to increase his intake of red meat just a little because it's not only his haemoglobin, RBC and haematocrit that are a little low, but his iron level as well. He's cut back on red and processed meat particularly over the past 5-6 months. He's also started Casudex in that time so likely the even greater reduction of testosterone caused by that is also a factor. For what it's worth all other iron indicators are very normal including ferretin.

Thanks once again.

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My local medonc had me start taking Ferro-Sequels (iron supplements) which did the trick, hemoglobin and RBC are back in normal range. I definitely feel the difference when exercising.

First he had me get a colonoscopy to make sure I didn’t have any bleeding in my gut causing it. Check with your doc about iron supplements.

Ed

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Thanks for your info and suggestions. In fact we saw the GP today and he also suggested a colonoscopy. He didn’t say, but I know it’s to rule in or out any possibility of colon cancer. Hopefully that’s not the cause but you have to find out one way or the other.

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It’s likely standard procedure just to rule things out, benign polyps can cause bleeding so I wouldn’t stress too much. It was actually one of the easier tests I’ve had although the prep the night before is not much fun. He’ll have to go on a liquid diet the day before too - some good chicken broth helped me get through that. After the test the doc said “all was good see you in 10 years” - I certainly hope so!

Ed

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Thanks so much : )

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every 5 years....(for us)

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/05/2019 5:19 PM DST

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I’ve had Over four years on adt ...hmmmm ..fatigue ? I can relate .morbidity Doesn’t sound too good . Its like my friend said about contracting agent orange “ It saved my ass in the jungle “. Adt is the same ,sure a slurry of downsides but without it I surely would have died . No vacation from adt for me . I also had orchiectomy so hopes are dashed of a resurgence of”T” naturally . Facinating research as usual . Thank you .

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Thankyou for the reply, but don't really understand much of it. Are you saying he could be anemic ? isn't iron supposed to be bad for PC ? So what else could be done, looks like a trip to the Drs tomorrow.

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ADT can make you anemic for sure. I am in that situation now. My RBCs are low. His blood counts may also still be recovering from radiation. Have they been checked?

Also, Iron does not help with anemia unless low iron is the cause.

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Thanks, has your Dr prescribed anything to help you ?

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No. It's not that far out of range. It's normal for a woman, along with boobs, hot flashes, reduced muscle and bone loss.... Aaaah, the joys of ADT!

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yes, it sucks !

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I was at a support group and one guy says: "I hate ADT", then another. I said "I love ADT." They looked at me really funny like "what the heck?"

I said "I love it because it's keeping me alive." It's kind of like the Stockholm Syndrome where you fall in love with your abuser because you become dependent on the abuser to keep you alive.

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“ Stockholm syndrome” very funny . We learn to love our capture..

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Adt has whittled me down but has given me over four years of life that I wouldn’t of had with out it me think. I believe its from treatments and he will recover ..

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We get in touch with our feminine side...

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Hello Kim, It could be from the radiation . The combo with Lupron also.. Hope he perks up .. all of these treatments can cause this . I think he can outgrow it .. Take care,,🌵 Scott

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Thanks Scott, was really worried earlier, but seems to have perked up a bit now, see how he is in the morning. Hes come downstairs and he says he feels better than he was. No heart palpitations or racing pulse, just dizzy.

Thanks for your reply

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I’m sorry y to hear that he’s suffering . I think he will get better. Takes time to recovery from Rt.. I do use canabis oil. I believe it helps me with appetite and nausea. 🙏

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Why did you cut sugar out of his diet?.... He could be hypoglycemic. give him a bowl of ice cream and see how he feels

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Nearly everyone on this site, and everywhere else I have read, tells me that Sugar feeds Cancer, so Ive tried to illuminate most of it.

Still has honey on yogurt etc, and sugar free biscuits.

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First let me say, I did not mean to sound “confrontational”. That was not my intention.

I know what you do, is for the complete love you have for your husband. But In my opinion diet takes a lifetime to have any kinda of impact.

Changing ones diet at this time only throws one more variable into a equation that is already a nightmare.

Just eat good food, not a lot of anything. Just eat and talk and be with him. Me and my wife do that and I’ve never been happier in my life

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No offence taken, as you say im just doing 'what I can' in trying to help my husband. We eat better now than we have ever done, although saying that we have always eaten pretty healthily, no fast food, fried, had a bit of a sweet tooth , so now everything immoderation. Lots of fruit, etc...

I read HU most days and try my best to go with what the majority of men on here try they have been at it a lot longer than us.ie supplements, diet etc..Our OC is not into any of that, so with small changes that may or may not help.whoknows !

True this terrible disease has also brought us closer.

Kind Regards to you and your wife.

Kim

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Lucky we are to have love my friend . I wouldn’t care to be here without it..

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You are an absolute angel to your husband, just as my wife is to me, and has been all along my PCa journey. Oddly enough, (like you and your hubby) this PCa experience (and her own battle with tongue cancer a few years ago...hopefully cured) has brought us much closer together. We have definitely tested our vows of “in sickness and in health” to the max! 😎

I’m with Dean Nelson on the diet/nutrition issue, and it sounds like you are already on the right track in that area...everything in moderation. Our bodies convert virtually everything we consume into glucose to be used for energy. I do work hard to limit my intake of sugars and foods with a high glycemic index. But that is primarily to keep my Type 2 DM in check. However, we still occasionally go out for a special meal. Last week after church we had breakfast at a Cracker Barrel. I had French toast for the first time in several years...but I left half of it on my plate and used sugar free syrup. It was enough to satisfy my cravings with minimal impact.

I have discussed the diet & nutrition issues with my Mayo M.O. a few times. He suggested a sensible diet like the Mediterranean Diet, but not totally excluding occasionally having “comfort food” or treats...just make them occasional and special, not frequent. In here you will read the whole gamut from eating everything in sight to going totally vegan. Maybe the best answer is somewhere in between the two extremes? Who knows? Do whatever is comfortable for you and your husband, and enjoy your life.

Blessings to you both!

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Thankyou for a lovely reply. Yes definitely in this through thick and thin.

My husband takes all the Vits, I ply him, Tomato, pom juice, he wont give up met though. But only have red meat a couple of times week. You have to enjoy your life best you can, while you can. The clock is ticking for All of us.

Don't know if anything II am doing is helping in ANY way, but I must try, its the only thing I can control. Also makes ME feel better, being pro-active.

Bless you and your wife,

Kim

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Amen 🙏 to that Dean! My wife and I do the same. 😎

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☝️I am with you on sugar .. especially if one eats way too much ..

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I think this may or may not be true. But I definitely think it is not good to be too extreme when it comes to cutting something out that our bodies were once so used to. Surely the occasional piece of chocolat won't do him any harm, or a coke in the morning or afternoon... If his glukose levels are low he would definitely feel something like you describe.

Mel.

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Two scoops. I am also anemic. Gradually going down for 2 and a half years. Blood work up a little this time. No one seems to care much.

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I do monte.

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I care too Monte

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When I felt my world was over I remember the ones that wrote to me and kept me sane

Husband is still here and because of you guys

I take one day at a time and thank God

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👏

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That’s what we’re here for, Collar. We are all different, but in here, and I know it’s a trite saying, we are all family. I’m not sure that I ever thought it possible to genuinely care about people I’ve never met...until I joined this group.

May God bless you and your hubby with a long and happy life together. 😎

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I do too Monte.... now let's sit down and have some chocolate chip ice cream (two scoops)...

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/05/2019 5:25 PM DST

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Hi Kim,

Sorry to hear your husband feels dizzy. Like the other members have advised, keep checking vitals, stay hydrated, boost nutrition intake and have the doctor check for anemia. I wanted add that your husband may have also developed a touch of positional vertigo. You may want to have doctor check for this. I suffer from this and when it hits, I feel crappy for a few days with dizziness and low energy. Hope he feels better soon 🙏

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Thankyou for reply, ive been looking at what causes this, an it sounds very similar to Vertigo.

Today after a good nights sleep, he feels back to normal ?

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Oh yah!

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Hi Kim

My husband had same initially

We too took him in and his BP was actually high which is apparently a side effect of his current tx being enzalutamide

But prior to starting he would have dizziness a few days after Lupron injection

After initial diagnosis he took a good look at his diet

Sugar was the first to go

But he does feel dizzy at times and eating anything seems to improve that

All the best

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Thanks he had his Lupron inj 2months ago, and hes not on any other medication But if it happens again Im taking him straight to the A&E.

Thanks for your reply

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Atrial fibrillation is another situation that can produce those effects. My partner has dealt with it for about ten years now so I can relate that it is easy to miss or overlook. The symptoms vary a bit from incident to incident, but fatigue, dizziness, weakness, and fuzzy thinking are a big part of it. A simple BP check will not necessarily catch it, indeed we have been in both doctor's office and the ER when it happened and they both missed it. So learn to take a pulse by palpating the wrist arteries and do it frequently so you know what

"normal" feels like. Afib will have rapid, weak, irregular, or nearly impossible to find pulses. Typically an incident passes spontaneously with rest and it is treatable but is something that a cardiologist needs to monitor. My partner is in Afib about 2% of the time, some folks live with it at 50%; for him incidents are clearly stress and anxiety related. I'm not making a diagnosis here, just suggesting that this other non-prostate treatment related condition may be triggering the same set of symptoms. We tend to focus on what we know is going on, or our first hunches, and sometimes need to step back to see the alternatives.

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Thanks for the info.Hes back to normal today,wierd !But will monitor him and speech to our Dr about these episodes ( had one 3 weeks ago)

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I’ve had all of those symptoms but don’t have a fib or high bp thank God ...

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Check his blood pressure when he’s dizzy, I had to go on some blood pressure pills because of some that 🙏🙏

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Sound advcie from others, I think he should have a normal amount of sugar in his diet and also keep a check on his heart. My husband has AF more than 50% of the time, he has meds for it. but sometimes feels nausea.

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Did he have a fib prior to pc?

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Cutting out as much sugar as possible is always wise, even for healthy people. I’m not a doctor by any means, but I doubt that this is the root cause of your hubby's symptoms. I’m also Type 2 diabetic, so I have already eliminated as much sugar from my diet as possible. If you have any doubts about his sugar levels you can get a kit (no Rx needed and available at all pharmacies), and do the finger pricks to monitor his blood glucose levels. My family doc put me on Metformin a couple of years ago. It has helped keep my blood glucose numbers stable, with the added benefit that it has been shown to be a potent prostate cancer weapon.

As noted by pjoshea and Gregg 57, and (refer to the “askdrmyers” link from pj), nearly all men on ADT are anemic, and low iron is usually not the root cause of the anemia. It is more likely caused by low testosterone resulting from the ADT. Most men get sufficient iron intake from their diets, so unless you have verified low ferritin counts, iron supplementation will not help you. In fact, it can be harmful.

I tried taking Slow Fe before I saw Dr. Myers’ video. It didn’t help. My RBC, hemoglobin, and hematocrit have been low since I started on ADT 4 years ago. My Mayo M.O. monitors it (along with other CBC counts and my PSA and testosterone levels) every 3 months. My hematocrit & hemoglobin have never been below (or even close to) the 10/30 level to warrant getting a blood transfusion to boost my RBC and related counts.

I’ve come to accept that my fatigue and weakness are likely going to be with me for as long as I am on ADT, and adjust my activity and expectations accordingly. It is my “new reality,” along with hitting my driver under 200 yards. 🏌️⛳️😎.

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Its the new us! Hahaha

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Thankyou for all your replies to my question, much appreciated, will speak with our Dr about all my concerns.

Hes back to normal today like nothing ever happened !

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So let's hope this will not happen again, whatever caused it. Good luck. And if it happens again, speak to his oncologist and GP about it. In the meantime, keep up the good care.

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Go to Walgreens or a similar store and purchase a blood pressure measurement device. Take his blood pressure when he experiences these episodes of lightheadedness. I am on Lupron and very rarely have had this prolonged episode. See his doctor about this. Alert his office and see what their Triage procedure involves.

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Thanks

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I am also experiencing the same side effects. Being new to this (2 months) the side effects started shortly after the Lupron shot. Exercise does help. I have not found anything in the diet that helps. I also am one that is not good at staying hydrated. I will ask the Dr. about the blood counts, but blood pressure and heart beat have remained good during these times. Being a golfer, getting through 9 holes is not an issue, but I have yet to finish the back 9 because of the side effects.

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Hope the Drs can sort us BOTH out.

My hubbie has been on Lupron a year next week.No real side effects, bit achy hot flashes, tired, but not this before 3 weeks ago !

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Hey FGSmith, since starting Luporn, I have to stay hydrated or I get massive headaches. It takes effort to stay on top of it.

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Answer: Start with the back nine first............

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/05/2019 5:29 PM DST

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Drive for show ,put for dough .. keep hitting it..

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I’m a golfer, too, albeit it a very bad one. I’ve been on ADT for over 4 years. At first it was a struggle to finish 18 holes. It wiped me out. It took time, but eventually I either adapted to the side effects, or they subsided...maybe both. The important thing is to keep going out there and playing. It will do your body (and mind & soul...it’s my “chicken soup”) a lot of good. Best wishes to you. Hit ‘em well! 🏌️⛳️😎

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I experienced extreme fatigue and some dizziness and general weakness for months after RT and being on Lupron for 18 months. I had low RBC and WBC for a long time afterwards as well. These abated several months after stopping ADT. I was advised by my RO and on this site to engage in weight training and aerobic exercise, which really helped with the fatigue and other weakness effects. It's difficult to exercise when you don't feel up to it, but for me, that was an indicator that I needed to exercise. I hope that will help your husband.

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Thanks for your advice

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I have been on Luron continuously since 2013. Usually in the morning I wake up with a headache and am a little lightheaded. I usually rest for a while and then am okay for the rest of the day.

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thankyou

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Mornings can be a little rough .

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Talking dizziness...

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/05/2019 5:37 PM DST

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You constantly make us smile😀😀😀😀😀

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They're in training to pass DWI tests....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/05/2019 8:29 PM DST

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Blimey, even I would be dizzy after doing that !

Your funny j-o-h-n, you should be on the telly.

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Benny Hill, was my hero.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 08/06/2019 10:31 AM DST

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Yes, one of my favourite English comics, That theme tune is still associated with him many years after his death. One funny (bit risky) man.

Never thought the Benny Hill show would be available in the US. just shows you.

Take care

Kim

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Hi Kim,

I can understand that this makes you worried. It would do the same with me.

I can't say anything about the medication your husband is on as my husband never had that one. However, if this is one of the side-effects, perhaps yhe is feeling them very much?

But I would also talk about this either with your GP if you can't get to the hospital at the moment or with your husband's oncologist. It should definitely be checked out.

Cutting out the sugar could also be a problem, in which case it would be low sugar which makes him feel that way. But I don't actually think that this would be the case if otherwise his diet is normal and he is eating enough.

Have you thought of dehydration? Dehydration is often the cause for dizziness and nausea and can cause severe headaches. Maybe monitor how much he is drinking. He may be thinking that he is drinking much but it mightn't be much at all.

Love, Mel.

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Thankyou for your reply, all of your points are valid, we see our GP next week, and going to get him checked out.

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