Is this bruising normal?

[Pirate3]

My husband was diagnosed 4 years ago with stage IV PCa , mets to bones- hips, pelvis, sacrum, with a Gleason 4+4. Received Taxotere initially. Currently on Yonsa (insurance switched him from Zytiga) and methylprednisolone, plus the bad boy Lupron of course. Here is my question: he bruises horribly from the slightest touch. His skin is literally like tissue paper, mostly of the arms, and peels up or tears from the slightest touch. There is blood all over our house from where he has brushed up against something and his skin ripped back. He wears long sleeves to try to protect his skin, and because the sight of his arms embarrasses him. We've shown the MO and asked several times about it. The answer is a vague "must be his medicine". That seems the standard answer for everything . At our last appointment the NP did look at his blood work more closely and his platelets are low but not alarmingly low (126,000).

I guess I have a second question too- his balance Is off. He fell 3 days ago but didn't tell me about it until the next day. When I looked, I found a huge hematoma, a swollen elbow, and skin that had literally burst from the swelling- In addition to a large area where the skin had just peeled off. I feel so bad for him. Of course it is now New Years Day and a Friday so I guess we wait until Monday to have it seen.

I'm getting really nervous about this. Is this anyone else's experience? The fragile skin and the bruising? And the balance issues? He's only 61 years old and was strong as an ox before PCa struck out of the blue. Please respond if you can. Thank you so much.

[LearnAll]

He is having imbalance in his blood clotting mechanism. .possibly caused by his medicines.

Ask his doctor to order (1) Prothrombin Time (2) INR and (3) Re Check Serum Platelet Count. Reviw all his meds and supplements and dietary stuff for blood thinning quality.

If platelets go below 50000 ,it can lead to life threatening bleeding. Platelets can be increased rapidly within 5 to 7 days by ..prednisone or Papaya Leaf Extract. Please note that ..this is not a prescription. Its for your information only.

[Shooter1]

Reading this I realized I hadn't fallen for three weeks. Maybe winter agrees with me. During the summer I usually fell at least once a week. The least little bit off balance and my neuroptic feet just won't catch me. Also bruising a lot but platelets higher and don't bleed much from my paper skin. Don't know if its normal for most people but it is my new normal. Same mets, Gleason 4/5, and was strong as an ox till 67. On the up side, I no longer smell like an old goat after heavy exercise.

[LearnAll in reply to Shooter1]

Falling and getting injured is 2 times more in men who are on Lupron + Zytiga/Extandi type meds. The fall risk continues even after stopping ADT. Overweight and Obese have higher risk of falling.

Fall risk is lower when using only Lupron but much higher with addition of Zytiga or Extandi type meds to Lupron. How long the ADT is continued also determines how high fall risk will be. Intermittent ADT has lower risk of Fall than Continuous ADT. Exercise and muscle balance training can reduce falls.

For more details, Read the study below:

ncbi.nlm.nih.gov/pmc/articl...

[Shooter1 in reply to LearnAll]

I know I fell at least 25 times this last year. Long ago I learned to tuck and roll when falling. Only fell hard twice when feet got entangled in water or air hoses. In garden I just learned to crawl around to do weeding and such. Also crawl through huckleberry patches and only stand up when looking for another patch and have learned to use a walking stick on every outing.(I keep it right by the back door). PCP got me PT when I showed that anytime I crouched down I fell over. Lots better now.

[LearnAll in reply to Shooter1]

Your PCP has referred you for PT.. which is good. Physical therapists can teach how you can keep muscle balance and be aware of position of your limbs and trunk to move in safe manner. Mental awareness and watchfulness is a major factor in preventing falls. Using all your sense organs.. eyes, ears, touch etc can prevent falls to some extent ...or at least make them less damaging.

[Shooter1 in reply to LearnAll]

Thankfully no worse than a small scrape on my shoulder this last year....

[Tall_Allen]

Is he getting adequate Vitamin C and Vitamin K? I also wonder if an estrogen patch might help. Maybe make an appointment with an endocrinologist.

[Pirate3]

A big thanks to all for your input. I intend to push for the MO to rule out any correctable causes at our next appointment. Thanks again for the responses.

[Hidden]

I am 62, having been diagnosed 27 months ago with about the same, stage 4, metastatic, Gleason 4+4. And I have the same issues with my skin (especially the arms) but I started to notice it about 8 to 10 years ago, with my skin first starting to rip easier, and bleeding under the skin due to minor abrasions. Now just brushing something will rip my skin with lots of bleeding. ADT for the cancer seemed to make my skin even more paper thin, and prone to damage. Bleeding/bruising also got worse. I’ve had lots of tests such as clotting, and nothing was ever found. My dad had it later in life beginning at 75, so I thought it was genetic (mostly Norwegian/Swedish ancestry).

My balance was poor when on abiraterone/prednisone. It’s gotten better now that I have stopped them.

[Gearhead]

FYI, there was a related post on bruising a few weeks ago:healthunlocked.com/advanced...

[Hidden]

Bruising is part of the aging process, period. Many old people fall. A propensity to fall is indicative of other issues. Please understand this happens to people, men and women, who are cancer clean.......

GD

[TeleGuy]

Thin fragile skin is a side effect of the prednisone. I’m the same way, I’ll brush up against something and start bleeding. Easy bruising on my arms and calves.

[Graham49]

My experience is the same as TeleGuy. I take Prednisone as part of my medication for a Kidney transplant and it has the same effect.

[dentaltwin]

Corticosteroids are the most obvious cause for your husbands skin fragility. But your description of a "hematoma" suggests that there is a chance this could be something else, such as a dermatologic condition characterized by vesicles and bullae, such as bullous pemphigoid. If you think the oncologist might be pooh-poohing your concerns, you may want to consider a visit to a dermatologist.

[elvismlv123]

A few years ago I was using cortisone on a itch down below where the sun doesnt shine, and the dermatologist didnt want me to use it too long as it thins out your skin.BTW it didnt work.The steroids do that. So I would start there to remedy your husbands condition. The platelet count is fine. Methylprednisolone is the bad actor or some como effect with it and something else. Lupron is not it but it may be combining somehow.Dare you put some burn meds on the skin. Boost B vitamins. Run it all past a Dermo guy familiar with this. get a bunch on board. They know best . You are talking to the wrong side of the horse. Oncs dont zip about these things.What gets me is they dont care....Dose reduction of anything may help to reduce symptoms. Today they like to overdose to kill the cancer and most people cant take it.Normally blood thinners cause bruising like this.

[Pirate3]

Thank you for your real-life experience. That’s exactly what I was looking for!

[TrashPanda72]

I thought the “head rush” when standing was one of those “free” side effects. 😂.

It is terrible - and I have only been on Lupron/Zytiga for about 5 months. I am lucky not to have actually wiped out yet, and not dealing with the bruising/ bleeding / skin issues yet.

[j-o-h-n]

....eussi ecnalab elbirret a gnivah m'I (spleh rorrim)

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 01/03/2021 11:01 PM EST

[NEHOG]

First, I like most here have the same problem. As I have tried to be very active regardless of disabilities, the fragile skin issue has been a problem.

I finally was able to find a possible way to help (not eliminate) the problem, a skin medication called Tretinoin Gel. My oncologist prescribed it for me, (Saying she didn't think it would help...) and I've been using it for a month or so. It takes a while for the stuff to work, but in the last few weeks I have not broken the skin on my arms once! I still get bruises which I can live with, it is when I have breaks in the skin it is a problem.

tretinoin is prescription, and available in several strengths. I'm using 0.025%.

[Pirate3 in reply to NEHOG]

Thank you! I'll be asking our onc for a prescription at our next appointment. Appreciate your sharing!